Characteristics and outcomes associated with anxiety and depression in a head and neck cancer survivorship cohort

Purpose: To assess the prevalence and predictors of mental health disorders (MDHs) among head and neck squamous cell carcinoma (HNSCC) survivors, and the association with health-related quality of life (HRQOL), pain, and survival outcomes. Materials and methods: This was a retrospective, cross-sectional study of HNSCC survivors surveyed at an outpatient oncology clinic from May 2012 through July 2016. Results: Among 198 HNSCC survivors, 21% reported a MHD. Female sex (OR 6.60, 95% CI 2.08 to 20.98; p = 0.001) and Medicare insurance status (OR 4.95, 95% CI 1.52 to 16.11; p = 0.008) were significant predictors of reporting a MHD in the fully adjusted model. Patients reporting a MHD reported significantly worse pain (p < 0001) and worse HRQOL on the PROMIS Physical (p < 0.001), PROMIS Mental (p < 0.001), and FACT-GP (p < 0.026) questionnaires. Diagnosis of a MHD was not correlated with 5-year OS (74% vs. 84%; p = 0.087). Conclusion: Initiatives for early identification and intervention of MHDs as part of survivorship initiatives may engender clinically meaningful outcomes in head and neck cancer

Shared Decision-making in Head and Neck Surgery A Review

Importance Shared decision-making is a partnership between physicians and patients whereby patient values and preferences are incorporated with the best medical evidence. Shared decision-making may reduce decisional conflict, improve value-choice congruence, and increase patient involvement. Despite potential benefit in many key areas of otolaryngology-head and neck surgery, both clinical and research focuses on shared decision-making are scarce. Head and neck surgical oncology is of particular interest owing to the frequency by which preference-sensitive decisions must be made. Information used in this review was obtained between January 1 and February 1, 2020. Observations Various conceptual models have been developed in an attempt to define the concept of shared decision-making. More than 40 instruments have endeavored to measure the construct of shared decision-making. However, in head and neck surgery, few studies to date have explicitly done so. Situations of clinical equipoise, such as in the management of indeterminate thyroid nodules and in the treatment of laryngeal cancer, are frequent. In contrast, value-option incongruence may occur when patient values do not align with the most oncologically sound treatment choice, such as when the resection and reconstruction of oral cancer may leave patients with significant sequelae. Several patient decision aids have been developed to improve shared decision-making in specific clinical scenarios, for example, in considering total laryngectomy or primary chemoradiotherapy. Conclusions and Relevance Despite its potential benefit, there is a dearth of research and clinical applications of shared decision-making in head and neck surgery. Shared decision-making represents an area of substantial need in this regard, and additional efforts should be put forth.This narrative review discusses the concepts and development of tools to improve shared decision-making among patients who are undergoing head and neck surgery and surgeons.Analysis and support of clinical decision makin

Shared Decision Making for Surgical Care in the Era of COVID-19

The global pandemic caused by severe acute respiratory syndrome coronavirus 2 has upended surgical practice. In an effort to preserve resources, mitigate risk, and maintain health system capacity, nonurgent surgeries have been deferred in many jurisdictions, with urgent procedures facing increasing wait times and unpredictability given potential future surges. Shared decision making, a process that integrates patient values and preferences with the scientific expertise of clinicians, may be of particular benefit during these unprecedented times. Aligning patient choices with their values, reducing unnecessary health care use, and promoting consistency between providers are now more critical than ever before. We review important aspects of shared decision making and provide guidance for its perioperative application during the coronavirus disease 2019 pandemic.Analysis and support of clinical decision makin

Remote sensing of geomorphological and ecological change in response to saltmarsh managed realignment, The Wash, UK

An integrated remote sensing approach quantified saltmarsh dynamics in response to a sudden change in surface elevation due to a saltmarsh restoration scheme. The biogeomorphological relationship between surface elevation and saltmarsh presence occurs over the long-term so can be difficult to observe, though the ‘managed realignment’ of coastal defences provides a unique experimental opportunity to study this relationship. Realignment at Freiston Shore, Lincolnshire, UK in August 2002 caused a sudden and high-magnitude sediment input into the local coastal system, significantly increasing the intertidal surface elevation. The resulting impacts on the external, fronting saltmarsh were quantified by aerial photography and airborne multispectral imagery. Algal and pioneer saltmarsh boundary positions were calculated from 1984 to 2006, with the latter zone migrating slowly seaward pre-realignment (3.8 m a−1), but advancing significantly post-realignment (21.3 m a−1). Classification of five-year multispectral imagery accurately showed subtle changes in vegetation community composition within these boundaries. The realignment site was also colonized rapidly compared to other restoration sites, due to its high starting surface elevation. This study shows how, with sufficient sediment input and accommodation space, coastal management decisions can release intertidal surfaces from physical constraints to saltmarsh colonization