Monthly Archives: November 2012

Food preservatives don’t preserve oral cancer

Source: bigkingken.wordpress.com

Food preservatives are a common part of everyday life for those Americans who don’t go to extremes to avoid them. Twinkies will be around for thousands of years despite the dissolution of Hostess and I’m pretty sure there’s an unspoiled Big Mac somewhere that’s been hanging out for several decades.

Besides grossly keeping the hamburger on the left untarnished for more than a decade, food preservatives might be an untapped resource in the fight against cancer.

In short, food preservatives work by killing off any and all microbial life forms that come along to munch on the food before us humans have a chance to send it down to our bellies. Now, if these food preservatives are so effective at killing off unwanted bacteria in our food supplies, could they perhaps also be effective at killing off other unwanted life forms?

This is a question being asked by a lot of medical researchers at the moment, with at least one group finding an answer in the affirmative. Recently, researchers at the University of Michigan found that the common food preservative Nisin also does an excellent job of holding off – and even shrinking – the most common and deadly form of oral cancer, squamous cell head and neck cancer (HNSCC).

HNSCC is a particularly nasty form of cancer, seeing as it accounts for more than 90 percent of oral cancers yet hasn’t had its mortality rates improved in the past several decades. On the other side, Nisin is a particularly nasty strain of food preservative, in the sense that it is extremely deadly to unwanted bacteria. Approved for human consumption by the World Health Organization in 1969 and the FDA in 1988, about 0.6 mg of the substance is consumed per person per day.

So you might say that it is rather prevalent around the world.

Of course, the tiny amounts ingested on a daily basis isn’t near enough to fight off any other form of disease on its own. To figure out if it might have any pharmaceutical properties – especially to cancers – researchers pumped up the volume to the limits of tolerable exposure.

When introduced to food-borne bacteria, Lisin works by attacking the cell membranes that keep the outside world out of the cell and the guts of the cell safely tucked away. Once holes and pores are opened, it is open season for unregulated ions to flow in and out of the cell, effectively destroying the normal processes of life that rely on strictly managed comings and goings of life’s basic elements.

When introduced to rats with HNSCC, however, the effects aren’t quite as clear. From the initial studies, the substance certainly does something – namely killing off cancerous cells while also preventing tumors from spreading or growing. It’s the how that is the question.

At the moment, researchers speculate that it works in much the same way as it does in our food hordes – by disrupting the flow of calcium through the cell membrane. What’s more, it only does this to cancerous cells, due to intrinsic structural difference between them and normal, healthy cells. Another theory is that the food preservative somehow activates a protein called CHAC1 that is one of the main regulators of apoptosis – the pushing of a cell’s natural self-destruct button.

As you might expect, further studies are needed to delineate what exactly the cause of cancer cell cadavery is. But you can be sure there are plenty of people working on it mving forward, and also checking into other forms of food preservatives to see if they might be beneficial in other ways.

The study “Nisin, an apoptogenic bacteriocin and food preservative, attenuates HNSCC tumorigenesis via CHAC1” was conducted by Yvonne Kapila, professor at the University of Michigan School of Dentistry.

November, 2012|Oral Cancer News|

High school gamers are better than medical residents at robotic surgery

Source: killscreendaily.com
Author: Joseph Bernstein

Science Daily reports:

Both high school sophomores who played video games on average two hours per day and college students who played four hours of video games daily matched, and in some cases exceeded, the skills of the residents on parameters that included how much tension the subjects put on their instruments, how precise their hand-eye coordination was and how steady their grasping skills were when performing surgical tasks suck as suturing, passing a needle or lifting surgical instruments with the robotic arms.

“The inspiration for this study first developed when I saw my son, an avid video game player, take the reins of a robotic surgery simulator at a medical convention,” said Dr. Sami Kilic, lead author of the study and associate professor and director of minimally invasive gynecology in the department of obstetrics and gynecology at UTMB. “With no formal training, he was immediately at ease with the technology and the type of movements required to operate the robot.”

Kilic came up the idea for the study during a demonstration of the robotic da Vinci Surgical System. A company representative was giving surgeons turns manipulating the da Vinci, and one user was doing particularly well. Kilic, impressed, walked over to the operations console to see who the ace was.

“It was my 10-year-old son,” Kilic says.

Kilic’s son, and most of the test subjects, were shooting game buffs. Kilic says that the hand eye coordination and response time for people of his son’s generation will be so advanced by the time they enter medical school that new curricula for teaching surgery must be devised.

I tried to limn the case, in my review of Black Ops 2 last week, that we are training for things we don’t fully comprehend when we play games. I’m not arguing that everyone who overdoses on military shooters is a real-life killing machine, nor that everyone who gorges on Cooking Mama is Thomas Keller. I am arguing that games teach us skills – and not just the positive fuzzy ones like puzzle solving and creative thinking – that exist outside the context of the living room/subway/gaming environment.

The skills developed in youth significantly influence professional outcomes. I’m not sure what it says that gamers are preparing themselves to manipulate things remotely. These aren’t Robert Reich’s “symbolic analysts” – the lawyers, engineers, journalists and scientists (among others); mind workers who manipulate symbols and information for a living. They also aren’t really routine production workers – assembly line workers, because of the abstraction of their work.

This makes me think of the classic Far Side cartoon, in which the adoring parents watch their little fat child play a game on the floor as a thought bubble appears above them, revealing a newspaper wanted ad for “Nintendo experts” to “Save the princess” for six figures.

It also makes me wonder, finally, not just how we use the things we learn in gaming to make our world, but how the things we learn in gaming make us.

November, 2012|Oral Cancer News|

Ten year results of landmark neck cancer trial published

Source: www.modernmedicine.com
Author: Gabriel Miller

The latest data from a trial that opened in 1992 confirm that for locally advanced laryngeal cancer, sequential and concomitant chemoradiotherapy each produce similar survival rates, but the concomitant approach more often allows the larynx to be preserved.

When the results of RTOG 91-11 were first published in 2003. “they changed the standard of care treatment for preserving the larynx from the sequential use of chemotherapy then radiotherapy to giving both together,” said lead investigator Dr. Arlene Forastiere of Johns Hopkins University in an email to Reuters Health.

“The results have held up over the last decade,” she said, “…and this exact treatment remains the standard of care today because on average, 15% will ultimately require laryngectomy with the concomitant approach, compared to double that, or 30%, with either giving chemotherapy and radiation in sequence or giving radiotherapy alone.”

“There’s no question that this study has changed the way we approach and treat this disease, so it is truly a landmark study,” said Dr. Chris Holsinger, a head and neck cancer surgeon at MD Anderson Cancer Center in Houston, Texas who wasn’t involved in the research.

Between 1992 and 2000, 547 patients were randomly assigned to three treatment groups: induction chemotherapy followed by radiation; concomitant chemoradiotherapy; and radiotherapy alone.

The induction group received up to three cycles of cisplatin 100 mg/m2 on day one and fluorouracil 1,000 mg/m2 per day for five days, every three weeks. Responders then received up to 70 Gy of radiotherapy in 35 treatments of 2 Gy fractions.

Those in the concomitant chemoradiotherapy group received cisplatin 100mg/m2 on days 1, 22, and 43 of radiation treatments.

Those in the radiotherapy-only group received only 70 Gy of radiation.

All of the patients had stage III or IV squamous cell cancer of the supraglottic or glottic larynx that was considered curable with laryngectomy and radiotherapy. The primary outcome measure was “laryngectomy-free survival,” which was measured after a median of 10.8 years of follow-up in the current report. Late toxicity was also measured.

Overall survival at both five and 10 years was not significantly different between any of the groups, ranging from 54%-58% and 28-39%, respectively.

There was also no significant difference in the cumulative incidence of grade 3-5 toxicities between the groups. At ten years, the rates were 30.6%, 33.3% and 38% for induction chemotherapy followed by radiation, concomitant chemoradiotherapy, and radiotherapy alone, respectively.

However, in terms of larynx preservation, there was a significant advantage for concomitant cisplatin and radiotherapy, with a 54% relative risk reduction for laryngectomy compared to radiotherapy alone (p<0.001) and a 42% reduction compared with induction chemotherapy plus radiotherapy (p=0.005).

This trial was one of the largest and longest in the field to date. But head and neck cancer is a homogenous disease. “For head and neck cancers, in general, and for larynx cancer in particular, we don’t have a fully established standard,” said Dr. Jochen Lorch, a head and neck oncologist at Dana-Farber Cancer Institute in Boston who was not involved in the trial.

“My take would be this shows value in both approaches, induction and concurrent, but I think that you’re not going to get an answer about what’s the best way to treat this disease,” said Dr. Holsinger. “I definitely think that the clear value of the different approaches also opens up the path to studying minimally invasive surgery for this disease, especially neoadjuvant approaches.”

Newer induction regimens have also further clouded the picture.

“The cisplatin and 5-fluorouracil drug combination that was used in sequence with radiation has been replaced with a more effective regimen of three drugs,” said Dr. Forastiere. “We don’t yet know whether this newer induction regimen followed by radiotherapy would be as effective as concomitant treatment. That is a study that needs to be done.”

Full results of the trial were published online November 26 in the Journal of Clinical Oncology.

Source: J Clin Oncol 2012.

November, 2012|Oral Cancer News|

Global burden of cancer: opportunities for prevention

Source: The Lancet, Volume 380, Issue 9856, Pages 1797 – 1799, 24 November 2012

In The Lancet, Isabelle Soerjomataram and colleagues report that about 169 million years of healthy life were lost due to cancer worldwide in 2008 alone, based on a summary measure (disability-adjusted life-years [DALY] lost) that combines years lived with disability and years of life lost because of premature death. By contrast with mortality rates and counts, which emphasize deaths occurring at old ages, DALY give more weight to deaths occurring at young ages at which people are more likely to be working, raising children, and supporting other family members. Worldwide, the highest DALY rates were noted in eastern African countries (eg, Uganda, Zimbabwe, and Zambia) in women and in several high-income and middle-income countries (eg, Hungary and Uruguay) in men. Despite the substantial limitations inherent in the modeling of sparse cancer registry data and various assumptions about the natural history of every disease and related variables, these findings emphasize the growing burden of cancer in economically developing countries. This burden is partly due to the ageing and growth of the population and marketing-driven adoption of unhealthy lifestyles such as tobacco use and consumption of high-calorie food, as well as limited progress in reduction of infection-related cancers.2
Opportunities exist to reduce these major risk factors and the associated cancer burden through broad implementation of proven interventions specific to every country’s economic development level.

These interventions include tobacco control, improvement of opportunities for physical activity and healthier dietary patterns, and vaccinations against hepatitis B virus (HBV) and carcinogenic human papilloma virus (HPV) infections, which cause liver or cervical and other genital and oropharyngeal cancers, respectively.


Worldwide, more than a million cancer deaths are due to tobacco use every year.3 Although cigarette consumption and smoking-related cancer death rates are generally decreasing in developed countries, they are increasing in many developing countries because of intensive marketing by tobacco companies and increased affordability of cigarettes as economies develop.4, 5 In 2003, WHO established the Framework Convention on Tobacco Control (FCTC) to combat globalization of the tobacco epidemic through the coordinated implementation of proven tobacco control measures such as increases in taxes on tobacco products, smoke-free air laws, bans on tobacco advertising and promotion, and counter-advertising.6 However, progress in the implementation of these measures has been slow.6 As of 2010, only 31 countries had nationwide comprehensive smoke-free laws in public places to protect against exposure to second-hand smoke, and only 26 countries and one territory had total taxes of more than 75% of the retail price, with most of these being high-income countries.7

Obesity and physical inactivity have been associated with increased risk of cancers of the endometrium, colon and rectum, post-menopausal breast, kidney, and pancreas, and adenocarcinoma of the esophagus.8 Incidence rates for most of these cancers are on the rise in several countries partly because of the obesity pandemic in recent decades.9, 10 If no action is taken to halt or reverse these trends, they might wipe out the gains from the reduction in smoking-related cancers, especially in developed countries; notably, one study in the USA forecasted a potential decrease in life expectancy in the 21st century based on present obesity trends.11 In 2004, WHO published a global strategy to combat the unhealthy diets and physical inactivity that have led to the obesity epidemic.12 Recognizing obesity as a societal problem, WHO recommends a setting-based approach (eg, school, workplace, and community) to promote healthy eating habits and a physically active lifestyle.


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Infectious agents cause some of the most commonly diagnosed cancers (cervix, liver, and stomach cancers, and Kaposi’s sarcoma) in developing countries, accounting for about 22% of total cases.13 WHO has recommended HBV vaccine as part of routine national infant immunization programs since 1992 to reduce the disproportionately high burden of liver cancer in these countries. Although 179 (93%) of 193 of WHO member states have introduced HBV vaccine into their immunization program as of 2010, coverage is suboptimum (with less than 80% of infants receiving the third dose of the vaccine) in many countries in sub-Saharan Africa, where levels of chronic infection with HBV are among the highest worldwide.14 Furthermore, in 2006, a substantial proportion of infants did not receive the first dose within 24 h after birth to prevent potential transmission of infection from chronically infected mothers.15 The future burden of cervical cancer in low-income and middle-income countries could also be substantially reduced through an increase in the availability and dissemination of HPV vaccines to adolescent girls in these regions. The high burden of HIV infection-related cancers in sub-Saharan Africa could be reduced by greater efforts to promote safe sex and by a more widespread provision of highly active antiretroviral therapy to HIV-infected individuals.

Implementation of comprehensive and sustainable interventions to challenge the growing cancer burden in low-income and middle-income countries will require the coordinated efforts of many stakeholders from the public and private sectors, including national and international public health agencies, health industries, philanthropic and government donors, and local and regional policy makers. The UN High-level Meeting on Non-Communicable Diseases held on Sept 19—20, 2011, in New York, USA, could serve as a catalyst to mount such responses.

References

1 Soerjomataram I, Lortet-Tieulent J, Parkin DM, et al. Global burden of cancer in 2008: a systematic analysis of disability-adjusted life-years in 12 world regions. Lancet 2012. published online Oct 16. http://dx.doi.org/10.1016/S0140-6736(12)60919-2.
2 Stuckler D, McKee M, Ebrahim S, Basu S. Manufacturing epidemics: the role of global producers in increased consumption of unhealthy commodities including processed foods, alcohol, and tobacco. PLoS Med 2012; 9: e1001235. CrossRef | PubMed
3 Danaei G, Vander Hoorn S, Lopez AD, Murray CJ, Ezzati M. Causes of cancer in the world: comparative risk assessment of nine behavioural and environmental risk factors. Lancet 2005; 366: 1784-1793. Summary | Full Text | PDF(146KB) | CrossRef | PubMed
4 Bray F, Jemal A, Grey N, Ferlay J, Forman D. Global cancer transitions according to the Human Development Index (2008—30): a population-based study. Lancet Oncol 2012; 13: 790-801. Summary | Full Text | PDF(5850KB) | CrossRef | PubMed
5 Jemal A, Center MM, DeSantis C, Ward EM. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 2010; 19: 1893-1907. CrossRef | PubMed
6 WHO. WHO Framework Convention on Tobacco Control. Geneva: World Health Organization. http://whqlibdoc.who.int/publications/2003/9241591013.pdf. (accessed July 18, 2012).
7 WHO. WHO report on the global tobacco epidemic, 2011: warning about the dangers of tobacco. Geneva: World Health Organization. http://www.who.int/tobacco/global_report/2011/en/. (accessed July 18, 2012).
8 World Cancer Research Fund and American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Washington DC: AICR, 2007.
9 Eheman CHS, Ballard-Barbash R, Jacobs EJ, et al. Annual report to the nation on the status of cancer, 1975—2008, featuring cancers associated with excess weight and lack of sufficient physical activity. Cancer 2012; 9: 2338-2366. PubMed
10 Center MM, Jemal A, Ward E. International trends in colorectal cancer incidence rates. Cancer Epidemiol Biomarkers Prev 2009; 18: 1688-1694. CrossRef | PubMed
11 Olshansky SJ, Passaro DJ, Hershow RC, et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005; 352: 1138-1145. CrossRef | PubMed
12 WHO. Global strategy on diet, physical activity and health. http://www.who.int/dietphysicalactivity/strategy/eb11344/strategy_english_web.pdf. (accessed July 18, 2012).
13 de Martel C, Ferlay J, Franceschi S, et al. Global burden of cancers attributable to infections in 2008: a review and synthetic analysis. Lancet Oncol 2012; 13: 607-615. Summary | Full Text | PDF(731KB) | CrossRef | PubMed
14 WHO. Immunization surveillance, assessment and monitoring: immunization coverage. Geneva: World Health Organization. http://www.who.int/immunization_monitoring/routine/immunization_coverage/en/index.html. (accessed July 18, 2012).
15 Morbidity and Mortality Weekly Report. Implementation of newborn hepatitis B vaccination—worldwide, 2006. MMWR Morb Mortal Wkly Rep 2008; 57: 1249-1252. PubMed

This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.


November, 2012|Oral Cancer News|

Larry Hagman dies of throat cancer, ‘Dallas’ co-stars pay tribute

Source: www.newstank.co.uk

 

Dallas star Larry Hagman, who played the scheming oil tycoon J.R. Ewing in the television soap opera, passed away last Friday, at the age of 81. The Dallas actor was suffering from throat cancer. Larry Hagman’s sudden death is being mourned by friends and family alike.

After receiving the shocking news of Larry Hagman’s death, his Dallas co-stars Linda Gray, Patrick Duffy, Victoria Principal and Ken Kercheval paid tribute to the actor.

Brenda Strong was quoted as saying to E! News, “Being able to work with one of my childhood idols was a dream come true. He was one of the most resilient and positive people I’ve ever known. Larry’s tremendous talent and contribution as an artist is only surpassed by his gigantic heart and how beloved he was by his friends, especially Patrick and Linda.”

Larry Hagman rose to fame in 1965 when he was cast in the sitcom I Dream of Jeannie as astronaut Major Anthony Nelson. He then went onto become famous for his villainous role as J.R. Ewing on Dallas from 1978 to 1991.

Larry Hagman had once laughed off the idea of retiring, when he said, “I’d like to die onstage, so to speak. I love acting and I’ve had a wonderful career.”

Barbara Eden, Larry Hagman’s I Dream of Jeannie co-star said, “I still cannot completely express the shock and impact from the news that Larry Hagman has passed…I can honestly say that we’ve lost not just a great actor, not just a television icon, but an element of pure Americana. Goodbye Larry, there was no one like you before and there will never be anyone like you again.”

November, 2012|Oral Cancer News|

PET/MRI detects head/neck lymph node metastases

Source: www.drbicuspid.com
Author: DrBicuspid Staff

PET/MRI outperformed diffusion-weighted MRI (DWI-MRI) for detecting lymph node metastases in the staging of head and neck cancer patients, according to a study presented November 25 at the Radiological Society of North America (RSNA) annual meeting in Chicago.

Researchers from the University of Düsseldorf found that PET/MRI achieved accuracy of 93%, compared with 88% for DWI-MRI. PET/MRI also reached sensitivity of 72%, compared with 36% for DWI-MRI.

Lymph node status has prognostic value in head and neck cancer because patients with metastases need neck dissection and adjuvant treatment. Therefore, precise lymph node staging is a necessity, noted lead author Christian Buchbender, MD.

“Currently available imaging modalities are restricted in their diagnostic performance for lymph node metastases detection,” he added. “For example, CT and MRI fall short in sensitivity when compared to FDG-PET or FDG-PET/CT. On the other hand, FDG-PET/CT suffers from a large amount of false-positive results.”

Thus, new modalities or a combination of modalities are needed to improve lymph node metastases detection in these cancer patients, he said.

The prospective study included 14 head and neck cancer patients with a mean age of 67 years. Prior to surgery, the patients received both FDG-PET/CT and 3-tesla MRI, including diffusion-weighted imaging. The patients then underwent bilateral neck dissection.

Using image fusion software, the researchers created two sets of images. One set consisted of PET/MR images, which were created by fusing FDG-PET results with contrast-enhanced, T1-weighted, fat-saturated MR images. The second set consisted of DWI-MR images, created by fusing DWI results with T1-weighted, fat-saturated MR images.

Buchbender and colleagues then analyzed both sets of images for the presence of lymph node metastases and found that PET/MRI detected 26 (93%) of 28 lymph node metastases, compared with 20 (71%) detected by DWI-MRI.

“When we compared these results to available data on PET/CT, we found that PET/MRI pretty much equals the performance of PET/CT,” Buchbender added.

November, 2012|Oral Cancer News|

Do fruits and veggies offset tobacco/alcohol cancer risks?

Source: www.drbicuspid.com
Author: DrBicuspid Staff

Consuming fresh fruits and vegetables has been shown to reduce the risk of oral cancer, and now a new study suggests that these “protective effects” may impede the negative effects of tobacco and alcohol consumption with regard to cancer risk (Nutrition and Cancer, November 2012, Vol. 64:8, pp. 1182-1189).

For the study, researchers from the University of São Paulo assessed the association between frequent consumption of fruits and vegetables and the risk of oral cancer, comparing results between nonsmokers and smokers and nondrinkers and drinkers.

Their case-control study involved 296 patients with oral squamous cell carcinoma attended in three major hospitals in São Paulo, paired with 296 controls recruited from outpatient units of the same hospitals.

The researchers found that eating both fruit and vegetables was associated with prevention of the disease in light (odds ratio [OR] = 0.46; 95% confidence interval [CI] = 0.27-0.78) and heavy (OR = 0.30; 95% CI = 0.14-0.65) smokers.

For nonsmokers, no fruit (OR = 50; 95% CI = 0.22-1.12) or vegetable (for tomato, OR = 0.53; 95% CI = 0.31-0.93) was associated with reduced risk of oral and oropharyngeal cancer. Similar results were found with regard to drinking status, with OR = 0.51 (95% CI = 0.30-0.87) and 0.18 for fruits (95% CI = 0.07-0.45), respectively, for light and heavy drinkers.

“This observation suggests that the protective effect of fruit and salad intake may modulate the deleterious effects from tobacco and alcohol,” the researchers concluded.

November, 2012|Oral Cancer News|

Seed planted in cancer research

Source: www.ivanhoe.com

A cancer diagnoses usually means radiation therapy that will not only affect the tumor, but healthy cells as well. New approaches to cancer treatment have been tested and, according to data, one approach is working. The new procedure for treating solid tumors with radiation was highly effective and minimally toxic to healthy tissue in a mouse model of cancer.

Brachytherapy is a technique for treating solid tumors, including prostate cancer, which involves the surgical implantation of radioactive seeds within a patient’s tumor. The seeds expose the tumor cells to high level of radiation while minimizing the negative side effects.

However, brachytherapy has its limitations, said Wenge Liu, M.D., Ph.D., and associate research professor of biomedical engineering at Duke University in Durham, NC.

“The most prominent factor is the need for survival implantation and removal of the seeds.”
So the doctor and his team set out to eliminate the need for surgery.

They did this by generating an injectable substance called a polymer that was attached to a source of radioactivity and spontaneously assembled into a radioactive seed after being injected into the tumor.

“We believe that this approach provides a useful alternative to existing brachytherapy, which requires a complicated surgical procedure to implant the radioactive seeds,” Liu said. “Moreover, these injectable seeds degrade after the radiation is exhausted so they do not need to be surgically removed.”

The tumors were eradicated by a single injection in 67 percent of the mice that received the treatment after being transplanted with either a human head and neck cancer or prostate cancer. Injection of the radioactive polymers substantially delayed tumor growth in all mice.

Further analysis indicated no signs that cells outside the tumor had been exposed to significant amounts of radiation.

Source: Cancer Research, a journal of the American Association for Cancer Research

November, 2012|Oral Cancer News|

ONS Connections: External lymphedema scale developed for head and neck cancer

Source: www.oncologynurseadvisor.com
Author: Kathy Boltz, PhD

Lymphedema in patients with head and neck cancer can be described through an instrument that has been developed and validated, in research that was reported at the Oncology Nursing Society (ONS) Connections: Advancing Care Through Science conference.

Aggressive multi-modality treatment regimens for locally advanced head and neck cancer often lead to a damaged lymphatic system. Then, patients are at risk for developing secondary lymphedema. Assessing head and neck lymphedema had received little attention prior to this work.

These researchers sought to develop a scale to grade external lymphedema in patients with head and neck cancer. They used a conceptual framework of the continuum from fibrosis to lymphedema to direct the study, which had two phases.

The first phase of the study generated a proposed scale for head and neck external lymphedema. This scale came from the study conceptual framework, a literature review, and analysis of their previous study, which had compared and contrasted four current lymphedema scales to grade external lymphedema in patients with head and neck cancer. Then, they used expert feedback to revise the proposed scale.

The second phase of the study tested the revised scale by physically examining 30 patients with head and neck cancer and facial swelling. The patients had a mean age of 57.67 years (standard deviation 6.54 years), and 40% had oropharyngeal carcinoma.

The interrater reliability of the Head and Neck External Lymphedema Scale (HN-LE) was acceptable, since exact agreement on grading lymphedema severity occurred 83% of the time, 100% of the grades were within one grade, and kappa was 0.752 (P<.001). The research team is further developing and psychometrically testing the HN-LE Scale in a larger sample.

November, 2012|Oral Cancer News|

Study examines surgical outcomes after head and neck cancer at safety-net hospitals

Source: medicalxpress.com
Author: staff

Safety-net hospitals appear to provide head and neck cancer surgical care to a vulnerable population, without an increase in short-term mortality, morbidity, or costs, according to a report in the November issue of Archives of Otolaryngology – Head & Neck Surgery. “Safety-net hospitals provide a disproportionate amount of care to those who are uninsured or underinsured, including Medicaid beneficiaries and other vulnerable populations, compared with the average hospital,” according to background information in the article.

To determine the association between safety-net hospital care and short-term outcomes following head and neck cancer surgery, Dane J. Genther, M.D., and Christine G. Gourin, M.D., M.P.H., of Johns Hopkins University, Baltimore, reviewed data from adults who underwent an ablative procedure (a surgical removal or excision) for a malignant oral cavity, laryngeal (larynx; or voice box), hypopharyngeal (hypopharynx; area where the larynx and esophagus meet), or oropharyngeal (oropharynx; oral part of the pharynx) neoplasm in 2001 through 2008.

Safety-net burden was calculated as the percentage of patients with head and neck cancer who had Medicaid or no insurance.

Overall, 123,662 patients underwent surgery from 2001 through 2008, and were included in the analysis. The authors found that high safety-net burden hospitals were associated with an increase in length of stay but were not associated with an increase in costs of care, after controlling for all other variables, including hospital volume status. Additionally, safety-net burden was not associated with in-hospital mortality, acute medical complications or surgical complications, after controlling for all other variables. “These data suggest that safety-net hospitals provide valuable specialty care to a vulnerable population without an increase in complications or costs,” the authors conclude. “Health care reform must address the economic challenges that threaten the viability of these institutions at the same time that demand for their services increases.

Source: Arch Otolaryngology Head Neck Surg. 2012;138[11]:1015-1022

November, 2012|Oral Cancer News|