Mental adjustment to cancer and its relation to anxiety, depression, HRQL and survival in patients with laryngeal cancer - A longitudinal study

<p>Abstract</p> <p>Background</p> <p>Using a longitudinal design, aim of this study was to investigate the relation between mental adjustment to cancer and anxiety, depression, health-related quality of life (HRQL) and survival in patients treated for laryngeal cancer.</p> <p>Methods</p> <p>95 patients with Tis-T4 laryngeal cancer were assessed at one and 12 months after start of treatment, respectively, using the Mini-Mental Adjustment to Cancer Scale (Mini-MAC), the European Organisation for Research and Treatment of Cancer (EORTC) Study Group on Quality of Life core questionnaire (EORTC QLQ-C30) supplemented with the Head and Neck cancer module (QLQ-H&N35) and the Hospital Anxiety and Depression (HAD) Scale. For survival analyses patients were followed up for a median time of 4.22 years from inclusion.</p> <p>Results</p> <p>The most commonly used adjustment response at both occasions was Fighting Spirit. The use of adjustment responses was relatively stable over time. Correlation analyses showed that patients using Helpless-Hopeless and Anxious Preoccupation responses reported more anxiety and depression, as well as decreased HRQL. Tumour site and stage showed no effect on adjustment response. Survival analysis indicated that use of a Helpless-Hopeless response was related to poorer survival (HR 1.17, p 0.001).</p> <p>Conclusion</p> <p>The relation between adjustment responses Helpless-Hopeless and Anxious Preoccupation and anxiety, depression, HRQL and possibly poorer survival indicate that assessment of mental adjustment should be considered when planning treatment and rehabilitation in laryngeal cancer patients.</p

A pre/post analysis of the impact of the COVID-19 pandemic on the psychosocial work environment and recovery among healthcare workers in a large university hospital in Sweden

Background: The impact of the COVID-19 pandemic on workload, mental health, and well-being of healthcare workers, and particularly those on the front-line, has received considerable attention. Design and methods: We surveyed hospital employees about their working environment during the pandemic and identified departments which were negatively affected in comparison to the pre-pandemic situation, as well as factors contributing to this. Setting and participants We surveyed all hospital employees at Sahlgrenska University Hospital, Sweden in September 2020 and compared results across departments and to the results of a large employee survey from October 2019. Results: The overall impact of the pandemic on perceived working conditions and possibility for recovery differed among departments. During the pandemic, healthcare workers working with COVID-19 patients reported poorer working environments than other employees. Factors significantly related to perception of work environment and recovery during the pandemic included worries of being infected, departmental transfer, and having insufficient access to personal protective equipment. Men reported better working conditions than women in all, but one item and higher age was related to better perceived working environment. Conclusions: Our results indicate that the pandemic differentially affects hospital departments and underscores the multifactorial nature of this topic. Contributing factors to poor perceived working environment could be addressed at times of high workload, such as during the pandemic, including providing appropriate support to managers, ensuring possibility for recovery during working hours, and acknowledging worries about infection. Young healthcare workers and staff who are relocated due to the pandemic warrant special attention

Isotactic and syndiotactic alternating ethylene/propylene copolymers obtained through non-catalytic hydrogenation of highly stereoregular cis-1,4 poly(1,3-diene)s

The homogeneous non-catalytic hydrogenation of cis-1,4 poly(isoprene), isotactic cis-1,4 poly(1,3-pentadiene) and syndiotactic cis-1,4 poly(1,3-pentadiene) with diimide, formed by thermal decomposition of para-toluenesulfonylhydrazide, is examined. Perfectly alternating ethylene/propylene copolymers having different tacticity (i.e., isotactic and syndiotactic), which are difficult to synthesize by stereospecific copolymerization of the corresponding monomers, are obtained. Both isotactic and syndiotactic alternating ethylene/propylene copolymers are amorphous, with very low glass transition temperatures

Effects of total laryngectomy on olfactory function, health-related quality of life, and communication: a 3-year follow-up study

<p>Abstract</p> <p>Background</p> <p>As total laryngectomy results in loss of airflow through the nose, one of the adverse effects for a majority of patients is the reduced or complete loss of olfactory function. However, with the introduction of a new method, the Nasal Airflow-Inducing Maneuver (NAIM), an important technique is available for laryngectomized patients to regain the ability to smell. The purpose of the present study was to assess changes in olfaction, health-related quality of life (HRQL) and communication 3 years after NAIM rehabilitation.</p> <p>Methods</p> <p>18 patients (15 men and 3 women; mean age, 71 years) who had undergone laryngectomy and NAIM rehabilitation were followed longitudinally for 3 years. For comparison an age and gender matched control group with laryngeal cancer treated with radical radiotherapy was included. Olfactory function was assessed using the Questionnaire on Odor, Taste and Appetite and the Scandinavian Odor Identification Test. HRQL was assessed by: 1) the European Organization for Research and Treatment for cancer quality of life questionnaires; and 2) the Hospital Anxiety and Depression Scale. Communication was assessed by the Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer. Descriptive statistics with 95% confidence interval were calculated according to standard procedure. Changes over time as well as tests between pairs of study patients and control patients were analyzed with the Fisher nonparametric permutation test for matched pairs.</p> <p>Results</p> <p>Thirty-six months after rehabilitation 14 of 18 laryngectomized patients (78%) were smellers. There were, with one exception (sleep disturbances), no clinically or statistically significant differences between the study and the control group considering HRQL and mental distress. However, statistical differences (p < 0.001) were found between the study and the control group concerning changes in communication.</p> <p>Conclusion</p> <p>Olfactory training with NAIM should be integrated into the multidisciplinary rehabilitation program after total laryngectomy. Our study shows that patients who were successfully rehabilitated concerning olfaction and communication had an overall good HRQL and no mental distress. Moreover, the EORTC questionnaires should be complemented with more specific questionnaires when evaluating olfaction and communication in laryngectomized patients.</p

Self evaluation of communication experiences after laryngeal cancer – A longitudinal questionnaire study in patients with laryngeal cancer

<p>Abstract</p> <p>Background</p> <p>Aim of this longitudinal study was to investigate the sensitivity to change of the Swedish Self Evaluation of Communication Experiences after Laryngeal Cancer questionnaire (the S-SECEL), addressing communication dysfunction in patients treated for laryngeal cancer. Previous studies have highlighted the need for more specific questionnaires for this purpose.</p> <p>Methods</p> <p>100 patients with Tis-T4 laryngeal cancer were included prior to treatment onset. Patients answered four questionnaires at six occasions during one year; the S-SECEL, the European Organisation for Research and Treatment of Cancer (EORTC) Core Quality of Life Core Questionnaire (QLQ-C30) supplemented by the Head and Neck cancer module (QLQ-H&N35) and the Hospital Anxiety and Depression (HAD) scale. In addition, performance status was assessed. Differences within groups were tested with the Wilcoxon paired signed ranks test and between-group analyses were carried out using the Mann-Whitney <it>U </it>test. Magnitude of group differences was analyzed by means of effect sizes.</p> <p>Results</p> <p>The S-SECEL was well accepted with a response rate of 76%. Communication dysfunction increased at 1 month, followed by a continuous decrease throughout the year. Changes were statistically significant at most measurement, demonstrating the sensitivity of the S-SECEL to changes in communication over time. The S-SECEL and the EORTC QLQ-C30 with the QLQ-H&N35 demonstrated similar results; however the S-SECEL was more sensitive regarding communication dysfunction. The largest changes were found in the most diagnose specific items concerning voice and speech.</p> <p>Conclusion</p> <p>The S-SECEL was investigated in the largest Scandinavian longitudinal study concerning health-related quality of life (HRQL) in laryngeal cancer patients. The questionnaire was responsive to change and showed convergent results when compared to established HRQL questionnaires. Our findings also indicate that the S-SECEL could be a more suitable instrument than the EORTC QLQ-C30 with QLQ-H&N35 when measuring communication experiences in patients with laryngeal cancer; it is more sensitive, shorter and can be used on an individual basis. As a routine screening instrument the S-SECEL could be a valuable tool for identifying patients at risk for psychosocial problems and to help plan rehabilitation. It is therefore recommended for clinical use in evaluation of communication dysfunction for all patients with laryngeal cancer irrespective of treatment.</p

Variations in concerns reported on the Patient Concerns Inventory (PCI) in head and neck cancer patients from different health settings across the world

Background: The aim was to collate and contrast patient concerns from a range of different head and neck cancer follow-up clinics around the world. Also, we sought to explore the relationship, if any, between responses to the patient concerns inventory (PCI) and overall quality of life (QOL). Methods: Nineteen units participated with intention of including 100 patients per site as close to a consecutive series as possible in order to minimize selection bias. Results: There were 2136 patients with a median total number of PCI items selected of 5 (2-10). “Fear of the cancer returning” (39%) and “dry mouth” (37%) were most common. Twenty-five percent (524) reported less than good QOL. Conclusion: There was considerable variation between units in the number of items selected and in overall QOL, even after allowing for case-mix variables. There was a strong progressive association between the number of PCI items and QOL

Speech- and voice function and quality of life in laryngeal cancer patients with regard to treatment

The overall aim of the study was to identify differences between laryngeal cancer patients treated with total laryngectomy with treacheoesophageal speech and patients treated with radiotherapy with laryngeal speech. We also wanted to find suitable instruments for identification and rehabilitation of communication and quality of life problems. Further we wanted to describe differences between T3 and T4 laryngeal cancer patients treated with laryngectomy and patients treated with radiotherapy in a Swedish joint programme. Laryngeal cancer patients were assessed according to perceptual analysis of voice- and speech characteristics and quality of life (n=28), acoustic analysis (n=24), a communication experience questionnaire (n=93) and survival and locoregional control (n=160).In the auditory-perceptual voice- and speech ratings the irradiated laryngeal speakers showed significantly (p&lt;0.001) better results compared to the tracheoesophageal speakers, and inexperienced listeners rated the tracheoesophageal speakers significantly higher than the experienced listeners. However, the tracheoesophageal patients´ perceptual voice- and speech self-evaluation was significantly better when compared to the auditory perceptual evaluation.When patients treated with radiotherapy were compared to patients with laryngectomy regarding quality of life (QOL), global QOL was similar, and only small, nonsignificant differences were found (except for hoarseness). The results confirm that QOL is of a multifactorial subjective nature and that voice- and speech function is not the only dimension affecting QOL after treatment for laryngeal cancer.The successful alaryngeal tracheoesophageal speakers typically felt a strong sense of accomplishment, were rarely ashamed of their new voices, and appeared to be satisfied with the voices they managed to achieve, which might in part be due to modern techniques of speech rehabilitation (tracheoesophageal prosthesis) following laryngectomy.Both tracheoesophageal and irradiated patients could be distinguished regarding acoustic and temporal measures when compared to normal controls. For clinical purposes perceptual measures are superior to acoustic analysis in laryngeal cancer patients, but acoustic and temporal measures can be used in order to support and complement perceptual voice- and speech evaluation after treatment for laryngeal cancer.The study results showed voice- and speech related problems after treatment for laryngeal cancer not only for the laryngectomised patients who had lost the ability of vocal communication, but also for the patients treated with radiotherapy. This indicates the need of voice- and speech rehabilitation in both patient groups.In the psychometric evaluation of a communication experiences questionnaire; Swedish version-Self Evaluation of Communication Experiences after Laryngeal Cancer (S-SECEL), the results were satisfactory for the Environment and Attitude subscales, while the General subscale construct was not optimal (Cronbach´s alpha &gt;0.90, and 0.60), respectively.In a multicenter study, T4 patients treated with laryngectomy with or without radiotherapy had significantly better 5-year survival and locoregional control compared to T4 patients treated with radical radiotherapy. However, a non randomised study must be interpreted with caution, and in future treatment discussions the results must be related to the expanding treatment options for laryngeal cancer.Conclusion: Tracheoesophageal communication in laryngectomised patients might facilitate the psychosocial rehabilitation. QOL is affected by other factors than voice- and speech function in patients with laryngeal cancer, and voice- and speech rehabilitation is indicated in patients treated with radiotherapy as well as in laryngectomised patients. The S-SECEL can be used as an instrument for assessment of rehabilitation needs and outcome of psychosocial care in patients with laryngeal cancer