Sex Differences in Health Related Quality of Life in Head & Neck Cancer One Year After Treatment

Background: Head and neck cancer (HNC) makes up about 3% of all cancers and is treated with systemic therapy, radiation, surgery, or a combination of these. HNC treatment can be associated with decreased patient reported health related quality of life (HR-QoL), which can lead to depression. The majority of studies found that females reported worse patient reported HR-QoL than males, however, there were a few that did not have a significant difference in overall patient reported QoL. With the discovery of patient oriented outcomes (PROs) in clinical practice affecting patient satisfaction, provider-patient relationship, and overall patient mortality, it is vital to include PROs in the creation of treatment plans. Objectives: The objectives of this project are to highlight the differences in HR-QoL between men and women. Ultimately, using these PROs clinically will help to improve patient care, augment patient-provider trust, and optimize treatment plans. Using PROs and recognizing where unconscious biases of providers come into play is pinnacle, and this project aims to highlight how men and women\u27s experiences are different in the treatment of HNC. Methods: Participants were given the FACT-H&N instrument one year after treatment for head and neck cancer at a single tertiary academic center to assess different aspects of Hr-QoL. Sex differences were analyzed between the groups. A Wilcoxon Rank Sum test was performed to assess associations with sex and survey responses, as well as to assess associations with total laryngectomy and survey responses. Results: There were 100 participants from a single academic center of which 73% were men and 27% women. Several of the questions had significant differences between men and women: I feel ill (P=0.0299), I am satisfied with my family communication about my illness P=0.0075), I am satisfied with my sex life (P=0.0496), My voice has its usual quality and strength (P=0.0057), I can swallow naturally and easily (P=0.0437), and I can eat solid foods (P=0.0248). There were no significant differences between men and women with laryngectomies. Conclusions: Overall, men felt more ill, were less satisfied with their sex lives, were less likely to feel a normal strength and quality of voice, felt decreased ability to swallow normally, and felt they could not eat solid foods; women were less satisfied with communication about their disease to their families. For those who had undergone laryngectomy, there were no significant differences between men and women. Different aspects of quality of life for men and women are affected by head and neck cancer. Monitoring PROs are becoming increasingly standard of care for patients, and providers need to be equipped understand how to interpret data accordingly and understand the inherent biases

Directed differentiation of human bone marrow stromal cells to fate-committed Schwann cells

Transplantation of oligodendrocyte precursors represents a potential therapy for myelin disorders but requires a safe and accessible cell source. Here we report the directed differentiation of neural progenitors derived from adult bone marrow stromal cells (BMSCs) into oligodendrocyte precursors for cell therapy purpose. Neural progenitors among BMSCs could be culture expanded in non-adherent sphere-forming conditions and directed to differentiate along the oligodendrocyte lineage. BMSC-derived oligodendrocyte precursors (BM-OPs) differentiated into myelin basic protein (MBP)-positive oligodendrocyte when co-cultured with purified dorsal root ganglion (DRG) neurons. Injection of BM-OPs into the brain of myelin deficient Shiverer mice resulted in the generation of MBP-positive oligodendrocyte and compact myelin. Our results provided pointers to adult BMSCs as a readily accessible source of OPs towards cell therapy for myelin disorders.published_or_final_versio

Disparities in the Uptake of Telemedicine During the COVID-19 Surge in a Multidisciplinary Head and Neck Cancer Population by Patient Demographic Characteristics and Socioeconomic Status

This cohort study examines the association between patient demographic characteristics and socioeconomic status and engagement in telemedicine during the COVID-19 pandemic

Real time patient-reported outcome measures in patients with cancer: Early experience within an integrated health system

BACKGROUND: While patient-reported outcome measures (PROMs) have benefit in cancer clinical trials, real-world applications are lacking. This study describes the method of implementation of a cancer enterprise-wide PROMs platform. METHODS: After establishing a multispecialty stakeholder group within a large integrated health system, domain-specific instruments were selected from the National Institutes of Health\u27s Patient-Reported Outcomes Measurement Information System (PROMIS) instruments (pain interference, fatigue, physical function, and depression) and were administered at varying frequencies throughout each patient\u27s cancer journey. All cancer patients with an oncologic visit were eligible to complete the PROMs prior to the visit using a patient portal, or at the time of the visit using a tablet. PROMs were integrated into clinical workflow. Clinical partnerships were essential for successful implementation. Descriptive preliminary data were compared using multivariable logistic regression to determine the factors associated with method of PROMs completion. RESULTS: From September 16, 2020 to July 23, 2021, 23 of 38 clinical units (60.5%) implemented PROMs over 2392 encounters and 1666 patients. Approximately one third of patients (n = 629, 37.8%) used the patient portal. Black patients (aOR 0.70; 95% CI: 0.51-0.97) and patients residing in zip codes with higher percentage of unemployment (aOR: 0.07, 95% CI: 0.01-0.41) were among the least likely to complete PROMs using the patient portal. CONCLUSIONS: Successful system-wide implementation of PROMs among cancer patients requires engagement from multispecialty stakeholders and investment from clinical partners. Attention to the method of PROMs collection is required in order to reduce the potential for disparities, such as Black populations and those residing in areas with high levels of unemployment

Existence of a phase transition under finite magnetic field in the long-range RKKY Ising spin glass Dyx_{x}Y1−x_{1-x}Ru2_{2}Si2_{2}

A phase transition of a model compound of the long-range Ising spin glass (SG) Dy$_{x}$Y$_{1-x}$Ru$_{2}$Si$_{2}$, where spins interact via the RKKY interaction, has been investigated. The static and the dynamic scaling analyses reveal that the SG phase transition in the model magnet belongs to the mean-field universality class. Moreover, the characteristic relaxation time in finite magnetic fields exhibits a critical divergent behavior as well as in zero field, indicating a stability of the SG phase in finite fields. The presence of the SG phase transition in field in the model magnet strongly syggests that the replica symmetry is broken in the long-range Ising SG.Comment: 4 pages, 4 figures, to be published in JPSJ (2010

Evaluating Quality of Life and Functional Outcomes in Salvage Surgery for Head and Neck Cancer

Background: Unique challenges surround treatment for residual or recurrent head and neck squamous cell carcinoma (HNSCC). Of the limited treatment options for residual or recurrent HNSCC, salvage surgery is often the best option. However, salvage surgery can result in significant morbidity, affecting both quality of life (QoL) and functional outcomes. Few studies have examined QoL outcomes following salvage surgery in the setting of HNSCC. Objectives: To analyze head and neck related quality of life and functional outcomes in patients with head and neck cancer who underwent salvage surgery. Methods: In this IRB approved study, FACT-HN Version 4 was administered pre-operatively and 6 months post-operatively to patients undergoing salvage surgery for HNSCC between November 4, 2014 and April 27, 2020. Retrospective cohort analysis was performed on this population with major outcome being postoperative QoL score. Functional outcomes included postoperative tracheostomy and feeding tube status. QoL outcomes were compared with paired t-tests. Univariate logistic regression was used to determine characteristics associated with presence of permanent tracheostomy and feeding tube, defined as presence greater than 30 days. Results: Overall, 25 patients undergoing salvage surgery for HNSCC were included in this analysis. Primary tumor sites were larynx/hypopharynx (44.0%), oral cavity (24.0%), oropharynx (20.0%), salivary (4.0%), skin (4.0%), and unknown primary (4.0%). Salvage surgeries consisted of total laryngectomy (36.0%), definitive neck dissection (24.0%), mandibulectomy (16.0%), parotidectomy (8.0%), with total laryngectomy/total glossectomy, radical tonsillectomy, TORS base of tongue excision, and transoral laser laryngeal excision all comprising 4% of cases. Total QoL scores were not significantly different preoperatively to postoperatively (mean 108.7, 95% CI=97.7 to 119.7 vs. 103.8, 95% CI: 93.1 to 114.5; P=0.436, with maximum total score of 148). Patients with lower preoperative Emotional Well-Being (EWB) subscores demonstrated significantly worse EWB subscores postoperatively (postoperative mean: 17.0, 95% CI: 14.5 to 19.4 vs. 21.7, 95% CI: 20.0 to 23.4; P=0.002). Of patients who underwent tracheostomy tube placement, 53.8% (N=7/13) remained tracheostomy dependent long-term (\u3e30 d). Of patients who underwent feeding tube placement, 81.0% (N=17/21) remained feeding tube dependent long-term (\u3e30 d). Tracheostomy and feeding tubes remained in place with median durations of 3.02 months (range 0.16 to 20.55) and 10.13 months (range 0 to 24.89), respectively. All patients with T3/4 disease undergoing salvage surgery required long-term feeding tube (N=6). Conclusions: This study provides important information about quality of life and functional outcomes for patients undergoing salvage surgery for HNSCC. There is a high rate of long-term tracheostomy and feeding tube dependence following salvage surgery. While no difference was found in head and neck related quality of life total score and sub-scores at 6 months postoperatively, general emotional well-being preoperatively was most associated with general emotional well-being postoperatively. This information should be taken into consideration when counseling and managing patients with residual or recurrent HNSCC

A sandpile model with tokamak-like enhanced confinement phenomenology

Confinement phenomenology characteristic of magnetically confined plasmas emerges naturally from a simple sandpile algorithm when the parameter controlling redistribution scalelength is varied. Close analogues are found for enhanced confinement, edge pedestals, and edge localised modes (ELMs), and for the qualitative correlations between them. These results suggest that tokamak observations of avalanching transport are deeply linked to the existence of enhanced confinement and ELMs.Comment: Manuscript is revtex (latex) 1 file, 7 postscript figures Revised version is final version accepted for publication in PRL Revisions are mino