Health-related quality of life at 3 months following head and neck cancer treatment is a key predictor of longer-term outcome and of benefit from using the patient concerns inventory

INTRODUCTION: During clinical follow‐up it can be difficult to identify those head and neck cancer (HNC) patients who are coping poorly and could benefit from additional support. Health‐related quality of life (HRQOL) questionnaires and prompt lists provide a means by which patients can express their perceived outcomes and raise concerns. The first aim of this secondary analysis following a randomized trial was to explore which patient characteristics, at around 3 months following treatment completion (baseline), best predict HRQOL 12 months later. The second aim was to attempt to ascertain which patients were most likely to benefit from using prompt list. METHODS: Cluster‐controlled pragmatic trial data were analyzed. HRQOL was measured by the University of Washington Quality of life questionnaire (UW‐QOLv4). The prompt list was the Patient Concerns Inventory (PCI‐HN). RESULTS: The trial involved 15 eligible consultants and a median (inter‐quartile range) of 16 (13–26) primary HNC patients per consultant, with 140 PCI patients and 148 controls. Baseline HRQOL was the dominant predictor of 12‐month HRQOL with other predictors related to social, financial, and lifestyle characteristics as well as clinical stage and treatment. Although formal statistical tests for interaction were non‐significant the trend in analyses over a range of outcomes suggested that patients with worse baseline HRQOL could benefit more from the PCI‐HN. DISCUSSION: HRQOL early post‐treatment is a key predictor of longer‐term outcome. Measuring and using HRQOL and the PCI‐HN are not only surrogates for predicting HRQOL at 15 months post‐treatment, but also tools to help guide interventions

Social determinants of health-related quality of life outcomes for head and neck cancer patients

The influence of area-based and individual indicators of socioeconomic status (SES) on health-related quality of life (HRQOL) and patient concerns following head and neck cancer is complex and under-reported. The aim of this study is to use baseline data collected as part of a randomised controlled trial to provide greater detail on the attribution of SES to University of Washington Quality of Life version 4 (UWQOL v4), Distress Thermometer and European Quality of Life Five-Dimension Five-Level (EQ-5D-5L) outcomes. A total of 288 trial patients attended baseline clinics a median (Interquartile (IQR)) of 103 (71–162) days after the end of treatment. Area-based SES was assessed using the Index of Multiple Deprivation (IMD) 2019. Thirty-eight per cent (110/288) of patients lived in the most deprived IMD rank quintile. Less than good overall quality of life (31% overall) was associated with current working situation (p = 0.008), receipt of financial benefits (p < 0.001), total household income (p = 0.003) and use of tobacco (p = 0.001). Income and employment were significant patient level indicators predictors of HRQOL outcomes after case-mix adjustment. The number of Patient Concerns Inventory items selected varied significantly by overall clinical tumour clinical stage (p < 0.001) and by treatment (p < 0.001) but not by area IMD or patient-level deprivation indicators. In conclusion, interventions to improve employment and finance could make a substantial positive effect on HRQOL outcomes and concerns

Building Booster Separation Aerodynamic Databases for Artemis II

NASAs Artemis II mission will mark the return of humans to near-lunar space for the first time since Apollo. Shortly after launch on the Space Launch System (SLS), a critical phase of ascent occurs when 16 small rockets fire to push the boosters away from the core. Minimizing the risk of failure during separation requires the construction of multiple 13-dimensional databases, including perturbations in position, flight conditions, and engine thrust. The SLS Computational Fluid Dynamics team used NASAs FUN3D flow solver on the Pleiades and Electra supercomputers to run 5,780 simulations at nominal conditions and over 8,000 simulations with a core stage engine failure to generate the databases needed to verify the booster separation system for Artemis II

CFD Simulations of the Space Launch System Ascent Aerodynamics and Booster Separation

This paper presents details of Computational Fluid Dynamic modeling of the Space Launch System during ascent. The primary focus of the paper is the flow simulation of the vehicle during ascent using the Overflow Navier-Stokes code. Computations of 739 first-stage flight conditions covering a range of Mach numbers, angles of attack, and roll angles were computed. The overset grid system contained 375 million grid points, and over 28 mil- lion CPU hours were used in the simulations. The simulations were run on the Pleiades supercomputer at the NASA Advanced Supercomputer Center at Ames Research Center. The data products from this work include integrated line-loads, surface pressure coefficients, venting pressures, and protuberance air-loads. Detailed comparisons were made of the aerodynamic performance predicted by Overflow and the wind-tunnel derived aero- dynamic database. A small number of the cases were run with two different turbulence models and with two differencing schemes. These results were used to quantify the sensitivity to the choice of the turbulence model and to the differencing scheme. The paper also introduces an effort to use the inviscid, unstructured Cartesian solver Cart3D to compute the aerodynamics during booster separation. Adaptive mesh refinement is being used to enable accurate simulations of sixteen booster-separation-motor plumes. The use of this tool is explored in preparation for building a booster-separation aerodynamic database

Health-related quality of life in patients with T1N0 oral squamous cell carcinoma: selective neck dissection compared with wait and watch surveillance

Management of the neck in patients with clinical T1N0 oral squamous cell carcinoma (SCC) is controversial. The aim of this study was to report the health-related quality of life (HRQoL) in a consecutive group of patients with stage 1 disease at a time closest to two years after primary surgery. Of 216 patients treated between 2007 and 2012 (after excluding early death and regional recurrence), 195 were eligible. HRQoL was measured using the University of Washington quality of life questionnaire version 4. The overall response rate was 65% (126/195). HRQoL outcomes were good, but compared with patients in the wait and watch group, those who had selective neck dissection (SND) had more problems regarding appearance (14% compared with 1%, p = 0.008) and pain (19% compared with 6%, p = 0.04). Similar trends were seen for shoulder (14% compared with 8%), mood (16% compared with 8%), and speech (5% compared with 1%), and for poorer overall QoL (30% compared with 16%). It is difficult to establish why patients did or did not have neck dissection in a retrospective sample, but it is likely that those who had SND had larger tumours. The findings highlight the impact that SND has on HRQoL in domains such as appearance, pain, speech, swallowing, and chewing. Previous studies on SND have tended to focus on injury to the accessory nerve and shoulder function, but these new data emphasise the need to include other domains in future trials that compare wait and watch, SND, and sentinel lymph node biopsy