http://repub.eur.nl/res/aut/23149/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/34192/ 2011-07-01T00:00:00Z Background The purpose of this study was to describe patient characteristics and prognostic factors for survival in the palliative stage of patients with head and neck cancer. Methods Since November 2003, all patients with palliative head and neck cancer treated in our hospital have been recorded in a central database. In total, 262 deceased patients were included in this retrospective study. Results The reasons for palliation were inoperability, distant metastases, refusal of curative treatment, or poor condition. The mean palliative phase lasted 5.3 months for patients with squamous cell carcinomas. Involvement of a specialized nurse was significantly related with the number of admissions and place of dying. Multivariate analysis showed comorbidity and treatment to be independent predictors of survival in the palliative phase. Conclusion Comorbidity and palliative interventions are possible prognostic factors for survival. The involvement of a specialized nurse might be associated with an improved quality of life. http://repub.eur.nl/res/pub/25901/ 2011-05-19T00:00:00Z Purpose: There is reluctance in providing incurable cancer patients with recordings of their consultation. In this pilot-study, we explored the feasibility and utility of providing consultation recordings when patients are told a new diagnosis of non-curable cancer, and the impact of the recordings on quality of life and the openness to discuss cancer-related issues in the family. Method: Seventeen patients with a new diagnosis of incurable oesophageal or head and neck cancer were randomized to receive a CD (n = 10) or no CD (n = 7) of their consultation in which the diagnosis was told and the decision to provide only palliative care was discussed. Data were collected before consultation and 1 week and 1 month afterwards. After 1 month, patients allocated to the control group were offered to receiving the CD of their consultation as well. Results: No major technical or procedural problems were encountered. Three-quarters of the patients appreciated receiving the CD, which was listened to by 8/10 patients and by 10/10 others in the CD group. After 1 month, two-thirds of the patients in the control group also asked to receive the CD. We found a trend towards a poorer quality of life but an improved openness to discuss cancer-related issues, in the CD group. Conclusion: The provision of a CD recording on the consultation in which the transition from a curative to a palliative care stage was communicated is feasible and was well-received by most cancer patients and their family. These findings require however verification in a study with a larger sample size. http://repub.eur.nl/res/pub/19482/ 2010-07-01T00:00:00Z Purpose and objective of the research: In this cross-sectional study we used a self-regulation perspective to better understand the experience of psychological distress in head & neck (H&N) cancer patients and their partners. We examined which goals they valued and the extent to which patients and partners experience goal disturbance. Furthermore, associations were explored between goal disturbance, goal re-engagement, (goal)self-efficacy, and psychological distress. Methods and sample: H&N cancer patients and their partners, recruited from the Erasmus Medical Center Rotterdam (N = 40), were interviewed and completed questionnaires, assessing the above aspects of the self-regulation theory. Key results: H&N cancer patients and their partners experienced goal disturbance from the disease. Such disturbances were in patients significantly related to more psychological distress. Higher levels of goal re-engagement were related to less psychological distress, again only significantly in patients. More self-efficacy was significantly associated with less psychological distress in both patients and partners. Conclusions: Self-regulation abilities as goal re-engagement and self-efficacy may be screened and used as target in future psychological interventions, given their potential to decrease perceived psychological distress. In view of elevated levels of goal disturbances in partners, psychological support for caring relatives in such interventions is recommended. http://repub.eur.nl/res/pub/24394/ 2009-11-01T00:00:00Z Purpose: Comparison of quality of life (QoL) and side effects in a randomized trial for early hyperbaric oxygen therapy (HBOT) after radiotherapy (RT). Methods and Materials: From 2006, 19 patients with tumor originating from the tonsillar fossa and/or soft palate (15), base of tongue (1), and nasopharynx (3) were randomized to receive HBOT or not. HBOT consisted of 30 sessions at 2.5 ATA (15 msw) with oxygen breathing for 90 min daily, 5 days per week, applied shortly after the RT treatment was completed. As of 2005, all patients received validated questionnaires (i.e., the European Organization for Research and Treatment of Cancer [EORTC] QLQ-C30, EORTC QLQ Head and Neck Cancer Module (H&N35), Performance Status Scale): before treatment; at the start of RT treatment; after 46 Gy; at the end of RT treatment; and 2, 4, and 6 weeks and 3, 6, 12, and 18 months after follow-up. Results: On all QoL items, better scores were obtained in patients treated with hyperbaric oxygen. The difference between HBOT vs. non-HBOT was significant for all parameters: EORTC H&N35 Swallowing (p = 0.011), EORTC H&N35 Dry Mouth (p = 0.009), EORTC H&N35, Sticky Saliva (p = 0.01), PSS Eating in Public (p = 0.027), and Pain in Mouth (visual analogue scale; p < 0.0001). Conclusions: Patients randomized for receiving hyperbaric oxygen after the RT had better QoL scores for swallowing, sticky saliva, xerostomia, and pain in mouth. http://repub.eur.nl/res/pub/30098/ 2008-04-01T00:00:00Z Background. Little is known about how palliative care is experienced by patients with head and neck cancer and their relatives. The aim of this retrospective study was to analyze this care from the point of view of surviving relatives. Methods. Fifty-five surviving relatives of patients with head and neck cancer treated at our department were enrolled in this study. Forty-five returned a completed questionnaire. Results. Medical treatment during the palliative stage was judged as sufficient in most cases, but was often felt to be intrusive. The majority of patients had more need for psychosocial and physical support. Contact between head and neck surgeon and patient was sufficient. Many relatives found information about the terminal stage unsatisfactory. Conclusion. Not all aspects of palliative care for head and neck patients are sufficient, and improvements are, in our setting, necessary, specifically within the psychosocial field. This supports the initiation of our Expert Center to improve quality of life in the palliative stage. http://repub.eur.nl/res/pub/30520/ 2008-04-01T00:00:00Z Objective: Update a previous review examining associations between psycho-social factors and survival in head and neck cancer patients. Data sources: Searched Cochrane, Psych info and Embase for the period from 1 January 1995 to 1 June 2007, as well as personal and article reference lists and article archives. Study selection: Identified articles assessed by consensus for eligibility using following criteria: survival as outcome measure; psycho-social factors as prognostic indicators; results specifically for head and neck cancer patients, not including oesophageal or thyroid cancer. Seven of 64 articles fulfilled criteria. Data extraction: Data abstracted independently by two reviewers using pre-determined proformas. Quality also rated using Scottish Intercollegiate Guidelines Network 50 tool. Data synthesis: At baseline, expression of intense psycho-social complaints, higher self-perceived physical ability and self-reported high physical functioning were significantly associated with increased survival. Uncertainty about the diagnosis and treatment was found to be a negative prognostic indicator, as was being single, poor cognitive function, baseline fatigue and alcoholism. Overall quality of life and head and neck pain 12 months after date of diagnosis were found to be significantly associated with survival in one study. However, overall quality of life and depression at the time of diagnosis were not. Conclusions: There appears to be some association between selected psycho-social factors and long-term survival from head and neck cancer. However this relationship is currently neither strong nor proven, requiring examination by multi centred trials with standardisation of research definitions and methodologies, and examination of post-treatment psycho-social factors. http://repub.eur.nl/res/pub/36691/ 2007-03-01T00:00:00Z Objectives: Telemedicine applications carry the potential to enhance the quality of life of patients, but studies evaluating telemedicine applications are still scarce. The evidence regarding the effectiveness of telemedicine is limited and not yet conclusive. This study investigated whether telemedicine could be beneficial to the quality of life of cancer patients. Design and Measurements: Between 1999 and 2002, we conducted a prospective controlled trial evaluating the effects of a telemedicine application on the quality of life of patients with cancer involving the head and neck, using quality of life questionnaires that covered 22 quality of life parameters. All patients had undergone surgery for head and neck cancer at the Erasmus MC, a tertiary university hospital in The Netherlands. Patients in the intervention group were given access to an electronic health information support system for a period of six weeks, starting at discharge from the hospital. Results: In total, we included 145 patients in the control group and 39 in the intervention group. At 6 weeks, the end of the intervention, the intervention group had significantly improved QoL in 5 of the 22 studied parameters. Only one of these five quality of life parameters remained significantly different at 12 weeks. Conclusions: This study adds to the sparse evidence that telemedicine may be beneficial for the quality of life of cancer patients. http://repub.eur.nl/res/pub/16992/ 1998-09-16T00:00:00Z The number of new patients in the Netherlands each year diagnosed with head and neck cancer is about 21 00.1 This number will increase in the coming years because of progessive aging of the population and the particularly high birthrate post second world war, producing a cohort of children who are now at risk for developing head and neck cancer. Moreover, patients are currently 'in medical hands' for a longer time than before because of the introduction of treatment techniques for more advanced tumors and better palliative care. In 1995 the estimated number of patients alive with carcinoma of the most common sites of head and neck cancer was 9125.2 Traditionally, the medical treatment of head and neck tumors has been directed at irradicating the disease and aiming for a longer survival of the patient. Therefore, the main focus has been on clinical data such as localization, type and staging of the tumor and the effect of treatment, demonstrated by loco-regional control and survival. As Bailar and Gornick stated recently, the effect on mortality of new treatments, in the period 1970 through 1994, has been disappointing for most cancer sites.3 Also, the survival rate for head and neck cancer in 1994 was found largely unchanged since 1973. In the Netherlands, the 5-year overall relative survival for oral cavity cancer improved from 52 to 58%, for oropharynx cancer decreased from 38 to 30% and remained unchanged (70%) in laryngeal cancer.2 For the patients both quantity and quality of life are important. Today head and neck cancer patients and their healthcare providers are confronted with the effects of more aggressive treatment modalities introduced since the 70's. Fundamental life functions, like breathing, eating and speaking, and the bodily appearance of the patient, are often largely affected by tumor and treatment, often with severe consequences for daily life and social interaction.