Introduction: The goal of this study was to analyze the causes of death in patients with loco-regionally advanced squamous cell carcinoma (HNSCC) of the head and neck treated with multimodality treatment. Materiel: Th...Introduction: The goal of this study was to analyze the causes of death in patients with loco-regionally advanced squamous cell carcinoma (HNSCC) of the head and neck treated with multimodality treatment. Materiel: The mortality records of 138 advanced head and neck patients treated in our department with surgery and adjuvant (chemo) radiotherapy from 2007 to 2013 were collected and reviewed in this study.?Results: From May 2007 to January 2013, 138 patients were followed up with a median follow-up duration of 25 months. The 5-year overall survival (OS), disease-free survival (DFS) were 45%, and 56.1%, respectively. A total of 39 patients (28%) died during the follow-up period. Clearly, in this population, loco-regional relapse accounted for one of the most cause of death but acute and late or chronic treatment-associated causes leading to death occurred in almost 8% of the patients. Furthermore, the risk of death from head and neck squamous cell carcinoma (HNSCC) was greater in patients with hypopharynx cancer. Univariate analysis indicated that patients with N2b disease and above and vascular tumor embolism had a lower overall survival (p = 0.001 and p = 0.007 respectively). The multivariate analysis showed that N2b disease and above was an independent prognostic factor for poorer loco-regional control (p = 0.001). Conclusions: Patients with locally advanced head and neck cancer treated with surgery and adjuvant (chemo) radiotherapy are potentially curable but face significant risks of mortality from causes other than disease progression.展开更多
Head and neck cancer(HNC) represents the sixth most common malignancy and accounts for approximately 6% of new cancer cases annually worldwide. As life expectancy constantly increases, the onset of HNC in patients old...Head and neck cancer(HNC) represents the sixth most common malignancy and accounts for approximately 6% of new cancer cases annually worldwide. As life expectancy constantly increases, the onset of HNC in patients older than 65 years of age at diagnosis is not rare and up to one fourth of cases occurs in patients older that 70 years at age. Because elderly cancer patients are severely under-represented in clinical trials, there is a clear need to address the particular aspects of this specific patient group, especially in the context of novel multidisciplinary therapeutic approaches. The frailty of elderly patients with HNC is attributed to the high incidence of smoking and alcohol abuse in this malignancy and the presence of substantial cardiovascular, respiratory or metabolic comorbidities. In the current work, I provide an overview of current and emerging treatment approaches, in elderly patients with HNC. In particular, I discuss modern surgical approaches that improve radical excision rates while preserving functionality, the incorporation of modern radiotherapeutic techniques and the introduction of novel chemotherapeutic combinations and molecular targeted agents in an effort to reduce toxicity without compromising efficacy. Finally, there is an urgent need to increase accrual and active participation of elderly patients with HNC in clinical trials, including biomarker evaluation in biopsy specimens towards an individualized therapeutic approach.展开更多
Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the e...Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients展开更多
Background: With the recent aging of society, the need for medical treatment of elderly patients with head and neck cancer seems to have been increasing. Method: The present study analyzed all 103 patients with head a...Background: With the recent aging of society, the need for medical treatment of elderly patients with head and neck cancer seems to have been increasing. Method: The present study analyzed all 103 patients with head and neck cancer ≥80 years, and we compared results with those of the previous generation (Group P;range: 75 - 79 years) comprising 104 patients treated in the same period. Results: We provided treatment just as wanted and could not choose it often. The reasons were oncological factors such as unresectable tumor or distant metastasis, refusal of treatment, and physical factors such as poor PS or number of comorbidities. Conclusion: Treatment choices should be based on the wishes and motivations of the patient and the medical assessment of physical function. When a patient ≥80 years old is treated, the high incidence of complications and severity of the disease should be considered.展开更多
Background： Nowadays, social media tools such as short message service, Twitter, video, and web-based systems are more and more used in clinical follow-up, making clinical follow-up much more time- and cost-effective...Background： Nowadays, social media tools such as short message service, Twitter, video, and web-based systems are more and more used in clinical follow-up, making clinical follow-up much more time- and cost-effective than ever before. However, as the most popular social media in China, little is known about the utility of smartphone WeChat application in follow-up. In this study, we aimed to investigate the feasibility and superiority of WeChat application in clinical follow-up. Methods： A total of 108 patients diagnosed with head and neck tumor were randomized to WeChat follow-up （WFU） group or telephone follow-up （TFU） group for 6-month follow-up. The follow-ups were delivered by WeChat or telephone at 2 weeks, 1, 2, 3, and 6 months to the patients after being discharged. The study measurements were time consumption for follow-up delivery, total economic cost, lost-to-follow-up rate, and overall satisfaction for the follow-up method. Results： Time consumption in WFU group for each patient （23.36 ± 6.16 min） was significantly shorter than that in TFU group （42.89 ± 7.15 min） （P 〈 0.001 ）; total economic cost in WFU group （RMB 90 Yuan） was much lower than that in TFU group （RMB 196 Yuan）. Lost-to-follow-up rate in the WFU group was 7.02% （4/57） compared with TFU group, 9.80% （5/51 ）, while no significance was observed （95% confidence interval [CI]： 0.176-2.740; P = 0.732）. The overall satisfaction rate in WFU group was 94.34% （50/53） compared with 80.43% （37/46） in TFU group （95% CI： 0.057-0.067; P = 0.034）. Conclusions： The smartphone WeChat application was found to be a viable option for follow-up in discharged patients with head and neck tumors. WFU was time-effective, cost-effective, and convenient in communication. This doctor-led follow-up model has the potential to establish a good physician-patient relationship by enhancing dynamic communications and providing individual health instructions.展开更多
AIM:To describe clinical characteristics of head and neck cancer(HNC)patients with pain and those wishing to discuss pain concerns during consultation.METHODS:Cross-sectional,questionnaire study using University of Wa...AIM:To describe clinical characteristics of head and neck cancer(HNC)patients with pain and those wishing to discuss pain concerns during consultation.METHODS:Cross-sectional,questionnaire study using University of Washington Quality of Life,version 4(UWQOL)and the Patients Concerns Inventory(PCI)in disease-free,post-treatment HNC cohort.Significant pain on UW-QOL and indicating"Pain in head and neck"and"Pain elsewhere"on PCI.RESULTS:One hundred and seventy-seven patientscompleted UW-QOL and PCI.The prevalence of selfreported pain issues was 38%(67/177)comprising25%(44/177)with significant problems despite medications and 13%(23/177)with lesser or no problems but wishing to discuss pain.Patients aged under 65years and patients having treatment involving radiotherapy were more likely to have pain issues.Just over half,55%(24/44)of patients with significant pain did not express a need to discuss this.Those with significant pain or others wanting to discuss pain in clinic had greater problems in physical and social-emotional functioning,reported suboptimal QOL,and also had more additional PCI items to discuss in clinic compared to those without significant pain and not wishing to discuss pain.CONCLUSION:Significant HNC-related pain is prevalent in the disease-free,posttreatment cohort.Onward referral to a specialist pain team may be beneficial.The UW-QOL and PCI package is a valuable tool that may routinely screen for significant pain in outpatient clinics.展开更多
文摘Introduction: The goal of this study was to analyze the causes of death in patients with loco-regionally advanced squamous cell carcinoma (HNSCC) of the head and neck treated with multimodality treatment. Materiel: The mortality records of 138 advanced head and neck patients treated in our department with surgery and adjuvant (chemo) radiotherapy from 2007 to 2013 were collected and reviewed in this study.?Results: From May 2007 to January 2013, 138 patients were followed up with a median follow-up duration of 25 months. The 5-year overall survival (OS), disease-free survival (DFS) were 45%, and 56.1%, respectively. A total of 39 patients (28%) died during the follow-up period. Clearly, in this population, loco-regional relapse accounted for one of the most cause of death but acute and late or chronic treatment-associated causes leading to death occurred in almost 8% of the patients. Furthermore, the risk of death from head and neck squamous cell carcinoma (HNSCC) was greater in patients with hypopharynx cancer. Univariate analysis indicated that patients with N2b disease and above and vascular tumor embolism had a lower overall survival (p = 0.001 and p = 0.007 respectively). The multivariate analysis showed that N2b disease and above was an independent prognostic factor for poorer loco-regional control (p = 0.001). Conclusions: Patients with locally advanced head and neck cancer treated with surgery and adjuvant (chemo) radiotherapy are potentially curable but face significant risks of mortality from causes other than disease progression.
文摘Head and neck cancer(HNC) represents the sixth most common malignancy and accounts for approximately 6% of new cancer cases annually worldwide. As life expectancy constantly increases, the onset of HNC in patients older than 65 years of age at diagnosis is not rare and up to one fourth of cases occurs in patients older that 70 years at age. Because elderly cancer patients are severely under-represented in clinical trials, there is a clear need to address the particular aspects of this specific patient group, especially in the context of novel multidisciplinary therapeutic approaches. The frailty of elderly patients with HNC is attributed to the high incidence of smoking and alcohol abuse in this malignancy and the presence of substantial cardiovascular, respiratory or metabolic comorbidities. In the current work, I provide an overview of current and emerging treatment approaches, in elderly patients with HNC. In particular, I discuss modern surgical approaches that improve radical excision rates while preserving functionality, the incorporation of modern radiotherapeutic techniques and the introduction of novel chemotherapeutic combinations and molecular targeted agents in an effort to reduce toxicity without compromising efficacy. Finally, there is an urgent need to increase accrual and active participation of elderly patients with HNC in clinical trials, including biomarker evaluation in biopsy specimens towards an individualized therapeutic approach.
文摘Objective To discuss the postoperative curative effects of two surgical techniques of minimally invasive total hip arthroplasty (THA) using metal-on-metal largediameter and conventional diameter femoral head for the elderly patients
文摘Background: With the recent aging of society, the need for medical treatment of elderly patients with head and neck cancer seems to have been increasing. Method: The present study analyzed all 103 patients with head and neck cancer ≥80 years, and we compared results with those of the previous generation (Group P;range: 75 - 79 years) comprising 104 patients treated in the same period. Results: We provided treatment just as wanted and could not choose it often. The reasons were oncological factors such as unresectable tumor or distant metastasis, refusal of treatment, and physical factors such as poor PS or number of comorbidities. Conclusion: Treatment choices should be based on the wishes and motivations of the patient and the medical assessment of physical function. When a patient ≥80 years old is treated, the high incidence of complications and severity of the disease should be considered.
基金This work was partially supported by a grant from the National Natural Science Foundation of China （No. 81072224）.
文摘Background： Nowadays, social media tools such as short message service, Twitter, video, and web-based systems are more and more used in clinical follow-up, making clinical follow-up much more time- and cost-effective than ever before. However, as the most popular social media in China, little is known about the utility of smartphone WeChat application in follow-up. In this study, we aimed to investigate the feasibility and superiority of WeChat application in clinical follow-up. Methods： A total of 108 patients diagnosed with head and neck tumor were randomized to WeChat follow-up （WFU） group or telephone follow-up （TFU） group for 6-month follow-up. The follow-ups were delivered by WeChat or telephone at 2 weeks, 1, 2, 3, and 6 months to the patients after being discharged. The study measurements were time consumption for follow-up delivery, total economic cost, lost-to-follow-up rate, and overall satisfaction for the follow-up method. Results： Time consumption in WFU group for each patient （23.36 ± 6.16 min） was significantly shorter than that in TFU group （42.89 ± 7.15 min） （P 〈 0.001 ）; total economic cost in WFU group （RMB 90 Yuan） was much lower than that in TFU group （RMB 196 Yuan）. Lost-to-follow-up rate in the WFU group was 7.02% （4/57） compared with TFU group, 9.80% （5/51 ）, while no significance was observed （95% confidence interval [CI]： 0.176-2.740; P = 0.732）. The overall satisfaction rate in WFU group was 94.34% （50/53） compared with 80.43% （37/46） in TFU group （95% CI： 0.057-0.067; P = 0.034）. Conclusions： The smartphone WeChat application was found to be a viable option for follow-up in discharged patients with head and neck tumors. WFU was time-effective, cost-effective, and convenient in communication. This doctor-led follow-up model has the potential to establish a good physician-patient relationship by enhancing dynamic communications and providing individual health instructions.
文摘AIM:To describe clinical characteristics of head and neck cancer(HNC)patients with pain and those wishing to discuss pain concerns during consultation.METHODS:Cross-sectional,questionnaire study using University of Washington Quality of Life,version 4(UWQOL)and the Patients Concerns Inventory(PCI)in disease-free,post-treatment HNC cohort.Significant pain on UW-QOL and indicating"Pain in head and neck"and"Pain elsewhere"on PCI.RESULTS:One hundred and seventy-seven patientscompleted UW-QOL and PCI.The prevalence of selfreported pain issues was 38%(67/177)comprising25%(44/177)with significant problems despite medications and 13%(23/177)with lesser or no problems but wishing to discuss pain.Patients aged under 65years and patients having treatment involving radiotherapy were more likely to have pain issues.Just over half,55%(24/44)of patients with significant pain did not express a need to discuss this.Those with significant pain or others wanting to discuss pain in clinic had greater problems in physical and social-emotional functioning,reported suboptimal QOL,and also had more additional PCI items to discuss in clinic compared to those without significant pain and not wishing to discuss pain.CONCLUSION:Significant HNC-related pain is prevalent in the disease-free,posttreatment cohort.Onward referral to a specialist pain team may be beneficial.The UW-QOL and PCI package is a valuable tool that may routinely screen for significant pain in outpatient clinics.
