Effect of Radiotherapy on Functional and Health-Related Quality of Life Outcomes after Jaw Reconstruction.
Effect of Radiotherapy on Functional and Health-Related Quality of Life Outcomes after Jaw Reconstruction.
复制标题
放射治疗对颌骨重建后功能和健康相关生活质量的影响。
作者：
重建手术是头颈癌(HNC)治疗后恢复形态和功能的关键。这项横断面研究的目的是描述有HNC病史的患者接受下颌骨和/或上颌骨重建后的长期生活质量(QOL)和功能结果。在指数重建之前或之后接受放射治疗的患者报告的功能和生活质量结果显著较差，包括言语、吞咽、饮食、外表、微笑和对信息的满意度。吞咽、流口水、口腔能力和对信息的满意度随着手术时间的增加而恶化。女性和年轻患者也报告了较差的功能和生活质量结果，特别是言语和面部美学。了解颌骨重建的长期结果对于患者和临床医生做出关于治疗方案的循证决策都很重要。我们已经确定了几个有较差预后风险的群体，这些群体可能受益于加强的术前咨询和术后监测。缺乏长期健康相关的生活质量(HRQOL)和下颌骨和上颌骨重建后的功能结果。为了确定这些结果，对接受颌骨重建的有癌症病史的患者进行了横断面研究。参与者是从克里斯·奥布莱恩生命之家(澳大利亚悉尼)的颌骨重建程序数据库中确定的。符合条件的患者至少有一个月的随访，手术时年龄≥为18岁，有恶性肿瘤史。采用Face-Q头颈部癌模块(Face-Q H&N)测量患者的HRQOL。用Face-Q H&N、MD Anderson吞咽困难问卷(MDADI)和言语障碍指数(SHI)评定功能结果。共完成问卷97份(回复率62%)。受访者的平均年龄为63.7岁，其中61%为男性，%接受过放射治疗。放射治疗与10/14 Face-Q H&N量表、3个MDADI子量表和1个综合评分以及SHI的较差结果相关。照射和非照射患者之间的平均得分差异超过了MDADI和SHI的临床有意义的差异。口腔能力、唾液、说话和吞咽方面的问题随着手术后时间的增加而恶化。年轻患者报告说，他们对外表、微笑、说话和癌症的担忧更大。女性报告说，她们更担心外表和相关的痛苦。放射治疗病史对颌骨重建后的HRQOL和功能有很大影响。手术年龄和性别也是预后和相关痛苦的预测因素。对需要颌骨重建的患者进行治疗前咨询可能会提高头颈癌患者的存活率。
Reconstructive surgery is critical to restore form and function after treatment for head and neck cancer (HNC). The aim of this cross-sectional study was to describe long-term quality of life (QoL) and functional outcomes among patients with a history of HNC who underwent reconstruction of the mandible and/or maxilla. Patients who had radiotherapy either before or after their index reconstruction reported significantly worse functional and QoL outcomes, including speech, swallowing, eating and drinking, appearance, smiling, and satisfaction with information. Swallowing, salivation, oral competence, and satisfaction with information worsened with increasing time since surgery. Women and younger patients also reported worse functional and QoL outcomes, especially speech and facial aesthetics. Understanding long-term outcomes of jaw reconstruction is important for both patients and clinicians to make evidence-based decisions about treatment options. We have identified several groups at risk of poorer outcomes that may benefit from enhanced pre-operative counselling and post-operative monitoring. Long-term health-related quality of life (HRQOL) and functional outcomes following mandibular and maxillary reconstruction are lacking. To determine these outcomes, a cross-sectional study of patients with a history of cancer who underwent jaw reconstruction was undertaken. Participants were identified from a database of jaw reconstruction procedures at the Chris O’Brien Lifehouse (Sydney, Australia). Eligible patients had at least one month follow-up, were aged ≥18 years at surgery, and had history of malignancy. HRQOL was measured using the FACE-Q Head and Neck Cancer Module (FACE-Q H&N). Functional outcomes were measured using the FACE-Q H&N, MD Anderson Dysphagia Inventory (MDADI) and Speech Handicap Index (SHI). Ninety-seven questionnaires were completed (62% response rate). Mean age of respondents was 63.7 years, 61% were male, and 64% underwent radiotherapy. Treatment with radiotherapy was associated with worse outcomes across 10/14 FACE-Q H&N scales, three MDADI subscales and one composite score, and the SHI. Mean differences in scores between irradiated and non-irradiated patients exceeded clinically meaningful differences for the MDADI and SHI. Issues with oral competence, saliva, speaking, and swallowing worsened with increasing time since surgery. Younger patients reported greater concerns with appearance, smiling, speaking, and cancer worry. Women reported greater concerns regarding appearance and associated distress. History of radiotherapy substantially impacts HRQOL and function after jaw reconstruction. Age at surgery and gender were also predictors of outcomes and associated distress. Pre-treatment counselling of patients requiring jaw reconstruction may lead to improved survivorship for patients with head and neck cancer.
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DOI：
10.1186/s13014-020-01701-5
发表时间：
2021-01-05
期刊：
Radiation oncology (London, England)
影响因子：
--
作者：
Kubota H;Miyawaki D;Mukumoto N;Ishihara T;Matsumura M;Hasegawa T;Akashi M;Kiyota N;Shinomiya H;Teshima M;Nibu KI;Sasaki R
通讯作者：
Sasaki R
影响因子：
4.6
作者：
Kim, Yi-Jun;Kim, Jin Ho
通讯作者：
Kim, Jin Ho
DOI：
10.1046/j.1523-5394.1999.76006.x
发表时间：
1999-11-01
期刊：
CANCER PRACTICE
影响因子：
--
作者：
Dropkin, MJ
通讯作者：
Dropkin, MJ
影响因子：
--
作者：
Hanasono MM
通讯作者：
Hanasono MM
影响因子：
4.8
作者：
Llewellyn, C. D.;McGurk, M.;Weinman, J.
通讯作者：
Weinman, J.