morbidity – Oral Cancer News

Suicide: A Major Threat to Head and Neck Cancer Survivorship

Source: www.jco.ascopubs.comAuthors: Nosayaba Osazuwa-Peters, Eric Adjei Boakye, and Ronald J. Walker , Mark A. Varvares TO THE EDITOR: The article by Ringash that was recently published in Journal of Clinical Oncology provided a compelling narrative of both the improvements made in head and neck cancer survivorship, as well as the challenges created by longer-term treatment and associated toxicities. There are currently at least 280,000 head and neck cancer survivors in the United States. As the article by Ringash stated, the upturn in head and neck cancer survivorship in the last three decades has coincided with the emergence of human papilloma virus-positive oropharyngeal cancer, as well as a decrease in tobacco use in the general population. These make it a challenge to isolate survival gains as a function of improved therapy from the natural prognostic value of a diagnosis of human papilloma virus-positive oropharyngeal cancer. Whatever the case, the fact that more than one-quarter million Americans are currently alive after a diagnosis of head and neck cancer means there needs to be a more deliberate effort in longer-term management of treatment-related toxicities, some of which are lifelong. We agree with Ringash’s conclusion that new models of care need to be developed in response to the significant quality-of-life issues faced by patients with head and neck cancer. The Institute of Medicine publication From Cancer Patient to Cancer Survivor: Lost in Transition, also cited by Ringash, called for a clear individualized survivorship plan for cancer patients. There is a serious need for this model to [...]

Charlotte Parker2016-03-24T15:06:02-07:00March, 2016|Oral Cancer News|

Noncompliance to guidelines in head and neck cancer treatment; associated factors for both patient and physician

Source: 7thspace.com Author: staff Decisions on head and neck squamous cell carcinoma (HNSCC) treatment are widely recognized as being difficult, due to high morbidity, often involving vital functions. Some patients may therefore decline standard, curative treatment. In addition doctors may propose alternative, nonstandard treatments. Little attention is devoted, both in literature and in daily practice, to understanding why and when HNSCC patients or their physicians decline standard, curative treatment modalities. Our objective is to determine factors associated with noncompliance in head and neck cancer treatment for both patients and physicians and to assess the influence of patient compliance on prognosis. Methods: We did a retrospective study based on the medical records of 829 patients with primary HNSCC, who were eligible for curative treatment and referred to our hospital between 2010 and 2012. We analyzed treatment choice and reasons for nonstandard treatment decisions, survival, age, gender, social network, tumor site, cTNM classification, and comorbidity (ACE27). Multivariate analysis using logistic regression methods was performed to determine predictive factors associated with non-standard treatment following physician or patient decision. To gain insight in survival of the different groups of patients, we applied a Cox regression analysis. After checking the proportional hazards assumption for each variable, we adjusted the survival analysis for gender, age, tumor site, tumor stage, comorbidity and a history of having a prior tumor. Results: 17% of all patients with a primary HNSCC did not receive standard curative treatment, either due to nonstandard treatment advice (10%) or due to the patient choosing [...]

Oral Cancer Foundation News Team - A2015-07-13T13:44:32-07:00July, 2015|Oral Cancer News|

Improving QOL in head and neck cancer as survival improves

Source: www.medscape.com Author: Zosia Chustecka In patients undergoing radiation treatment for head and neck cancer, reducing the radiation to organs not affected by cancer is key to improving quality of life post-treatment. Several studies presented here at the 2014 Multidisciplinary Head and Neck Cancer Symposium described new approaches to sparing radiation delivered to the salivary glands and to the voice box, without any loss of cancer control, but with a reported reduction in adverse effects, such as xerostomia (dry mouth), and an anticipated reduction in loss of voice and speech quality. Improvements in such outcomes are becoming increasingly important as the epidemiology of head and neck cancer is changing, and the increase in human papillomavirus-positive disease means that patients are being diagnosed their 50s and will, in many cases, go on to live for decades after their definitive cancer treatment, researchers commented at a press briefing. Xerostomia can make it difficult to speak, as well as chew and swallow, and can lead to dental problems. "Dry mouth might seem trivial, but it actually has a significant effect on quality of life," commented Tyler Robin, PhD, an MD candidate in his final year at the University of Colorado Medical School in Denver. To reduce this adverse effect, intensity-modulated radiation techniques are already directing the beam away from the parotid gland, which is responsible for stimulated saliva production, for example during eating. But for the rest of the time, saliva is produced unstimulated from the submandibular gland. "This gland actually produces the [...]

Oral Cancer Foundation News Team - A2014-02-28T14:23:04-07:00February, 2014|Oral Cancer News|

Robotic surgery yields better quality of life for OC patients

Source: www.drbicuspid.com Author: Donna Domino, Features Editor Patients with oropharyngeal squamous cell carcinoma maintain a high quality of life a year after having transoral robotic surgery, according to a new study in the JAMA Otolaryngology -- Head & Neck Surgery (April 10, 2013). But elderly patients and those treated with adjuvant treatments such as external-beam radiation therapy and chemoradiation therapy do not, according to the study authors. Patients with oropharyngeal squamous cell carcinoma (OPSCC) have historically been treated with primary open surgery. However, cure rates were low, complication rates were high, and patient health-related quality of life (HRQOL) decreased, the researchers noted. Efforts to minimize morbidity and preserve organs have shifted treatments to primary external-beam radiation therapy or chemoradiation therapy, but these treatments are often associated with significant side effects and decreased quality of life, they added. Transoral laser microsurgery was pioneered in the 1990s by Wolfgang Steiner, MD, for laryngeal tumors and eventually adapted to the oropharynx. Since then, primary laser microsurgery has yielded favorable treatment outcomes for OPSCC patients, the researchers noted. Transoral robotic surgery (TORS), a more minimally invasive approach, was introduced in 2005 and has since been recognized as "oncologically sound," while also preserving function in OPSCC patients. Complication rates are low and swallowing function remains high, according to the study authors. Research has shown that speech, eating, social, and overall quality of life tend to decrease but remain high three months after TORS. However, long-term results among a significant number of patients are lacking. Long-term quality [...]

Oral Cancer Foundation News Team - A2013-04-25T08:14:15-07:00April, 2013|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 [...]

Oral Cancer Foundation News Team - A2012-11-20T19:06:44-07:00November, 2012|Oral Cancer News|

Oral gel contains cancer-preventing compounds derived from black raspberries

Source: www.dentistryiq.com Author: Maria Perno Goldie, RDH, MS, with the assistance of Allison Walker Maria Perno Goldie (MPG): I had the opportunity to interview Dr. Susan Mallery, who is a humble as she is intelligent. I had the assistance of Allison Walker, a freelance journalist who has been involved in dental publishing for more than 20 years. Dr. Susan Mallery (SM) is a Professor in the Division of Oral Surgery, Oral Pathology, and Anesthesiology at The Ohio State University, College of Dentistry, in Columbus, Ohio. Her research interests include oral cancer initiation, AIDS-related oral cancer and chemoprevention. Dr. Mallery has published articles in journals such as Cancer Research, Cancer Prevention Research, Molecular Pharmaceutics, Carcinogenesis and Clinical Cancer Research, to name a few. She graduated from The Ohio State University with her DDS and later returned to receive her oral pathology specialty training and a PhD in Pathology. Dr. Mallery is licensed by the Ohio State Dental Board and board certified by the American Board of Oral Pathology and American Academy of Oral Pathology. She belongs to the American Academy of Oral Pathology, American Board of Oral Pathology, American Association for Cancer Research, and is a Fellow of the American Association for the Advancement of Science. She is a consultant at The Ohio State University and James Cancer hospitals. MPG: Oral squamous cell carcinoma (OSCC) will be diagnosed in more than 36,000 Americans this year and has a particularly high mortality rate—as it will kill approximately 8,000 patients this year. As [...]

Oral Cancer Foundation News Team - A2012-03-15T11:56:00-07:00March, 2012|Oral Cancer News|

New optical oral cancer screening device should be developed

Source: worldental.org Author: staff Oral cancer is on the rise all around the world. According to the American Cancer Society there are almost 130,000 lethal cases that are attributed to this cancer disease annually. As such the need is every growing to better develop the methods for detecting oral cancer at an earlier stage. There is no satisfactory mechanism that currently exists to screen and detect early changes of the oral cavity in the general population. The situation is even more challenging in low resource areas and in developing countries, where a combination of the lack of expertise and the inadequate resources for oral cancer screening can mean even longer diagnosis delays, which can lead to higher mortality and morbidity. Oral cancer screening normally involves visual inspection of the entire tissue surface at risk under white light illumination. However, a number of oral cancer screening products have been designed to improve diagnostic outcomes have been commercialized and developed. Researchers continue to experiment with new and better ways to more accurately locate and distinguish potentially malignant lesions using advanced optical technologies. However, developing countries pose unique a challenge when it comes to a device that can be used by individuals with limited clinical expertise that is affordable. The goal is to provide a cost effective opportunity for oral cancer screening that will work with the persons available in those health systems. That means that you have to have a very low cost, battery powered device. No one has developed on yet [...]

Oral Cancer Foundation News Team - A2010-05-14T16:09:40-07:00May, 2010|Oral Cancer News|

SciClone announces topline results from Phase 2 clinical trial of SCV-07 for prevention of oral mucositis

Source: CNNMoney.com Author: press release SciClone Pharmaceuticals, Inc. today announced topline results from the company's phase 2 clinical trial of SCV-07 for the prevention of severe oral mucositis (OM) (World Health Organization, WHO scale, grades 3 to 4) -- a painful, debilitating, and costly toxicity caused by chemoradiotherapy regimens used to treat head and neck cancer. This proof of concept study was intended to provide an estimate of SCV-07's treatment effect and guide further studies of SCV-07 in addressing this serious unmet medical need. Patients receiving the study's higher dose (0.1 mg/kg) of SCV-07 showed a trend towards delay to onset of severe OM, the study's primary endpoint. Patients in the low dose treatment arm (0.02 mg/kg) appeared to do worse than placebo, suggesting that the treatment effect is sensitive to dose. Additionally, SCV-07 was safe and well tolerated with no drug-related serious adverse events reported, indicating that there is potential to administer higher doses of SCV-07 in future clinical studies. Additional data analysis showed a more pronounced clinical benefit for patients in the high dose treatment arm when evaluating the delay to onset of ulcerative OM (WHO scale, grades 2 to 4), an expanded measure of OM. In this analysis, the low dose treatment arm appeared similar or slightly better than placebo. "We are encouraged that the trial provides an indication of a biological signal, in the high dose arm, for the pre-specified primary endpoint of the study," said Stephen T. Sonis, DMD, DMSc, Senior Physician, Brigham and Women's [...]

Oral Cancer Foundation News Team - A2010-04-01T19:51:55-07:00April, 2010|Oral Cancer News|

Sentinel nodes predict spread in oral cancer

Source: www.medpagetoday.com Author: Michael Smith, North American Correspondent, MedPage Today In early oral squamous cell carcinoma, a sentinel node biopsy correctly predicted an absence of lymphatic metastasis in all but 4% of patients, researchers said. For T1 and T2 lesions that were clinically node-negative, the procedure -- combined with additional sectioning and immunohistochemistry -- yielded a negative predictive value of 96%, according to Francisco Civantos Jr., MD, of the University of Miami, and colleagues. For T1 lesions, the value was 100%, while for T2 cancers it was 94%, the researchers reported online in the Journal of Clinical Oncology. The finding may position the procedure as an intermediate option between watchful waiting and selective neck dissection, the researchers said, asserting that it's now "reasonable" to conduct a head-to-head trial of sentinel node biopsy and neck dissection. The procedure has significantly increased the sensitivity for detecting lymphatic metastasis in melanoma and breast cancer patients, Civantos and colleagues noted. But in oral cancer, many surgeons prefer a completion neck dissection, they added, despite the "measurable morbidity" that's associated with the procedure. On the other hand, because of that morbidity, other specialists prefer watchful waiting and elective neck irradiation. To investigate the issue, Civantos and colleagues conducted a multicenter trial in which patients with early invasive oral cancers were treated with both procedures -- a sentinel node biopsy, followed by completion selective neck dissection. The primary goal was to see if a negative hematoxylin and eosin finding on the sentinel node biopsy accurately predicted [...]

Oral Cancer Foundation News Team - A2010-02-09T21:42:01-07:00February, 2010|Oral Cancer News|

Ipsilateral irradiation for well lateralized carcinomas of the oral cavity and oropharynx: results on tumor control and xerostomia

Source: Radiation Oncology 2009, 4:33 Authors: Laura Cerezo et al. In head and neck cancer, bilateral neck irradiation is the standard approach for many tumor locations and stages. Increasing knowledge on the pattern of nodal invasion leads to more precise targeting and normal tissue sparing. The aim of the present study was to evaluate the morbidity and tumor control for patients with well lateralized squamous cell carcinomas of the oral cavity and oropharynx treated with ipsilateral radiotherapy. Methods: Twenty consecutive patients with lateralized carcinomas of the oral cavity and oropharynx were treated with a prospective management approach using ipsilateral irradiation between 2000 and 2007. This included 8 radical oropharyngeal and 12 postoperative oral cavity carcinomas, with Stage T1-T2, N0-N2b disease. The actuarial freedom from contralateral nodal recurrence was determined. Late xerostomia was evaluated using the European Organization for Research and Treatment of Cancer QLQ-H&N35 questionnaire and the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 3. Results: At a median follow-up of 58 months, five-year overall survival and loco-regional control rates were 82.5% and 100%, respectively. No local or contralateral nodal recurrences were observed. Mean dose to the contralateral parotid gland was 4.72 Gy and to the contralateral submandibular gland was 15.30 Gy. Mean score for dry mouth was 28.1 on the 0-100 QLQ-H&N35 scale. According to CTCAE v3 scale, 87.5% of patients had grade 0-1 and 12.5% grade 2 subjective xerostomia. The unstimulated salivary flow was >0.2 ml/min in 81.2% of patients and 0.1-0.2 ml/min in [...]

Oral Cancer Foundation News Team - A2009-09-01T20:59:48-07:00September, 2009|Oral Cancer News|