학술논문
Development of a Patient-Centered Functional Outcomes Questionnaire in Head and Neck Cancer.
Document Type
Academic Journal
Author
Mendez A; Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.; Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada.; Seikaly H; Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.; Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada.; Eurich D; School of Public Health, Clinical Epidemiology, University of Alberta, Edmonton, Alberta, Canada.; Dzioba A; Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.; Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada.; Aalto D; Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada.; Rehabilitation Medicine, Communication Sciences and Disorders, University of Alberta, Edmonton, Alberta, Canada.; Department of Oral and Maxillofacial Surgery, University of Turku, Turku, Finland.; Osswald M; Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.; Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada.; School of Public Health, Clinical Epidemiology, University of Alberta, Edmonton, Alberta, Canada.; Harris JR; Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.; Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada.; School of Public Health, Clinical Epidemiology, University of Alberta, Edmonton, Alberta, Canada.; O'Connell DA; Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, Alberta, Canada.; Institute for Reconstructive Sciences in Medicine, Misericordia Community Hospital, Edmonton, Alberta, Canada.; School of Public Health, Clinical Epidemiology, University of Alberta, Edmonton, Alberta, Canada.; Lazarus C; Division of Head and Neck Surgery, Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York.; Thyroid, Head and Neck Cancer Foundation, New York, New York.; Urken M; Division of Head and Neck Surgery, Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York.; Thyroid, Head and Neck Cancer Foundation, New York, New York.; Likhterov I; Division of Head and Neck Surgery, Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York.; Thyroid, Head and Neck Cancer Foundation, New York, New York.; Chai RL; Division of Head and Neck Surgery, Department of Otolaryngology-Head & Neck Surgery, Mount Sinai Beth Israel, New York, New York.; Thyroid, Head and Neck Cancer Foundation, New York, New York.; Rauscher E; Thyroid, Head and Neck Cancer Foundation, New York, New York.; Buchbinder D; Thyroid, Head and Neck Cancer Foundation, New York, New York.; Department of Oral and Maxillofacial Surgery, Mount Sinai Beth Israel, New York, New York.; Okay D; Thyroid, Head and Neck Cancer Foundation, New York, New York.; Department of Oral and Maxillofacial Surgery, Mount Sinai Beth Israel, New York, New York.; Happonen RP; Department of Oral and Maxillofacial Surgery, University of Turku, Turku, Finland.; Department of Oral and Maxillofacial Diseases, University of Turku Hospital, Turku, Finland.; Kinnunen I; Department of Oto-Rhino-Laryngology, Turku University Hospital, Turku, Finland.; Irjala H; Department of Oto-Rhino-Laryngology, Turku University Hospital, Turku, Finland.; Soukka T; Department of Oral and Maxillofacial Surgery, University of Turku, Turku, Finland.; Department of Oral and Maxillofacial Diseases, University of Turku Hospital, Turku, Finland.; Laine J; Department of Oral and Maxillofacial Surgery, University of Turku, Turku, Finland.; Department of Oral and Maxillofacial Diseases, University of Turku Hospital, Turku, Finland.
Source
Publisher: American Medical Association Country of Publication: United States NLM ID: 101589542 Publication Model: Print Cited Medium: Internet ISSN: 2168-619X (Electronic) Linking ISSN: 21686181 NLM ISO Abbreviation: JAMA Otolaryngol Head Neck Surg Subsets: MEDLINE
Subject
Language
English
Abstract
Importance: Incorporation of patient perspectives, or patient-reported outcomes, in functional outcome measures has been gaining prominence in the literature on reconstructive surgery.
Objective: To create and validate an instrument for measuring the main functional areas of concern for patients with head and neck cancer.
Design, Setting, and Participants: This 4-phase mixed-methods qualitative study was conducted from July 1, 2013, to June 30, 2016, in a quaternary head and neck oncology center in Edmonton, Alberta, Canada. Patients were recruited from 3 Head and Neck Research Network sites: University of Alberta (Edmonton, Canada), Mount Sinai Health Network (New York, New York), and University of Turku Hospital (Turku, Finland). The inclusion criteria included 18 years of age or older, diagnosis of squamous cell carcinoma involving the subsites of the head and neck (ie, oral cavity, oropharynx, hypopharynx, and larynx), and at least 1 year since treatment completion. Those patients who were undergoing additional active treatment or with evidence of disease recurrence were excluded. Data were analyzed from July 1, 2013, to June 30, 2016.
Main Outcomes and Measures: The primary outcome measures were the clinical correlation of the Edmonton-33 instrument scores with swallowing, speech, dry mouth, and chewing assessment outcomes.
Results: In total, 10 patients with head and neck cancer (mean age, 59.6 years; 6 men [60%]) were included in phase 1 of the study, 5 patients (mean age, 55.2 years) were included in phase 2, 10 patients were included in phase 3, and 25 patients with head and neck cancer (mean age, 62.6 years; 14 men [56%]) participated in the phase 4 validation. The Edmonton-33 instrument scores correlated strongly with the swallowing scores of the MD Anderson Dysphagia Inventory (r = 0.77; 95% CI, 0.49-1.0), the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35 (EORTC QLQ-H&N35) (r = -0.73; 95% CI, -1.0 to -0.44), and the modified barium swallow test (r = -0.60; 95% CI, -0.94 to -0.25). The instrument scores were also strongly correlated with the Speech Handicap Index scores (r = -0.64; 95% CI, -0.97 to -0.31), word intelligibility scores (r = 0.61; 95% CI, 0.27-0.95), and sentence intelligibility scores (r = 0.55; 95% CI, 0.19-0.91). A moderate to strong correlation was observed between the Edmonton-33 instrument and the EORTC QLQ-H&N35 scores in the dry mouth (r = -0.54; 95% CI, -0.91 to -0.18) and chewing (r = -0.45; 95% CI, -0.84 to -0.06) domains. The factor loading values for the domains of swallowing, speech, dry mouth, and chewing were all greater than 0.3. The mean factor loading values for the items related to swallowing were 0.71 (95% CI, 0.62-0.80) and for the items related to speech were 0.76 (95% CI, 0.72-0.80). The mean factor loading values for the items related to dry mouth were 0.71 (95% CI, 0.59-0.83) and for those related to chewing were 0.77 (95% CI, 0.69-0.85).
Conclusions and Relevance: The Edmonton-33 appears to be a validated instrument that will allow patients with head and neck cancer to assess and report their own functional outcomes. It could serve as a single comprehensive measure for functional outcomes.
Objective: To create and validate an instrument for measuring the main functional areas of concern for patients with head and neck cancer.
Design, Setting, and Participants: This 4-phase mixed-methods qualitative study was conducted from July 1, 2013, to June 30, 2016, in a quaternary head and neck oncology center in Edmonton, Alberta, Canada. Patients were recruited from 3 Head and Neck Research Network sites: University of Alberta (Edmonton, Canada), Mount Sinai Health Network (New York, New York), and University of Turku Hospital (Turku, Finland). The inclusion criteria included 18 years of age or older, diagnosis of squamous cell carcinoma involving the subsites of the head and neck (ie, oral cavity, oropharynx, hypopharynx, and larynx), and at least 1 year since treatment completion. Those patients who were undergoing additional active treatment or with evidence of disease recurrence were excluded. Data were analyzed from July 1, 2013, to June 30, 2016.
Main Outcomes and Measures: The primary outcome measures were the clinical correlation of the Edmonton-33 instrument scores with swallowing, speech, dry mouth, and chewing assessment outcomes.
Results: In total, 10 patients with head and neck cancer (mean age, 59.6 years; 6 men [60%]) were included in phase 1 of the study, 5 patients (mean age, 55.2 years) were included in phase 2, 10 patients were included in phase 3, and 25 patients with head and neck cancer (mean age, 62.6 years; 14 men [56%]) participated in the phase 4 validation. The Edmonton-33 instrument scores correlated strongly with the swallowing scores of the MD Anderson Dysphagia Inventory (r = 0.77; 95% CI, 0.49-1.0), the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Head and Neck 35 (EORTC QLQ-H&N35) (r = -0.73; 95% CI, -1.0 to -0.44), and the modified barium swallow test (r = -0.60; 95% CI, -0.94 to -0.25). The instrument scores were also strongly correlated with the Speech Handicap Index scores (r = -0.64; 95% CI, -0.97 to -0.31), word intelligibility scores (r = 0.61; 95% CI, 0.27-0.95), and sentence intelligibility scores (r = 0.55; 95% CI, 0.19-0.91). A moderate to strong correlation was observed between the Edmonton-33 instrument and the EORTC QLQ-H&N35 scores in the dry mouth (r = -0.54; 95% CI, -0.91 to -0.18) and chewing (r = -0.45; 95% CI, -0.84 to -0.06) domains. The factor loading values for the domains of swallowing, speech, dry mouth, and chewing were all greater than 0.3. The mean factor loading values for the items related to swallowing were 0.71 (95% CI, 0.62-0.80) and for the items related to speech were 0.76 (95% CI, 0.72-0.80). The mean factor loading values for the items related to dry mouth were 0.71 (95% CI, 0.59-0.83) and for those related to chewing were 0.77 (95% CI, 0.69-0.85).
Conclusions and Relevance: The Edmonton-33 appears to be a validated instrument that will allow patients with head and neck cancer to assess and report their own functional outcomes. It could serve as a single comprehensive measure for functional outcomes.