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Introduction: Prevalence rates of human papillomavirus positive (HPV+) head and neck cancers (HNC) have increased over the last decades. Communicating about HPV is an increasingly relevant part of HNC patient care. This systematic review was conducted to explore healthcare professionals' (HCP) views and experiences of discussing HPV with HNC patients. It also examined perceptions among different HCP groups of their professional roles in HPV discussions. Methods: A narrative synthesis of qualitative research was conducted. Three databases—Embase, PsycINFO and CINAHL+—were searched from January 2007 to August 2018. Relevant data were extracted and synthesised thematically. Results: Five studies were identified: four were qualitative and one used mixed methods. HCPs varied in their experience and views of discussing HPV. HCPs who engaged in these discussions believed they were beneficial for patients. All HCPs described the need to address their HPV knowledge deficits in order to provide clear HPV information. Changes in professional roles which were linked to HPV communication for HCPs involved in HNC patient care were also evident. Conclusions: Effective HPV discussions are an important part of patient‐provider interactions. Evidence‐based interventions and professional development activities which support HCPs in their HPV discussions with patients would be valuable. [ABSTRACT FROM AUTHOR]

Introduction: Patients with advanced‐stage head and neck cancers (HNC) endure a significant symptom burden and suffer greatly towards the end of their lives. Qualitative evidence can provide insight into how existing services meet their needs. We aimed to synthesise qualitative data from patients with advanced HNC and their carers to inform improvements to services and care. Methods: A systematic search was conducted in MEDLINE and EMBASE for studies containing qualitative data from patients with advanced HNC and their carers. An interpretive account was generated using the meta‐ethnography methodology. Results: We identified 8 studies including 38 patients and 25 carers. Twenty‐six themes were synthesised into five concepts: psychological impact and adjustment, physical limitations and deliverance of symptomatic care, communication and information needs from healthcare professionals, social support and dependence, and needs of the primary caregiver. We identified that patients had complex psychological needs, centred on uncertainty and fear of suffering. Patients desired full information and found poor communication highly distressing. There was a dearth of literature on the subjective impact of physical limitations. Patients became reliant on social networks, and those with lower quality relationships coped poorly. However, caregivers struggled to meet patients' complex needs, resulting in distress and isolation. Conclusions: Patients with advanced HNCs have complex needs that are not met in current systems. Further qualitative work focusing on the physical and psychological impact of advanced HNC would be of value. [ABSTRACT FROM AUTHOR]

Head and Neck ( H& N) cancer treatment can have a major detrimental impact on patient lives, and these issues can go unrecognised and be inadequately addressed. The aim of this paper is to compare the Patient Concerns Inventory ( PCI) responses across age groups attending routine H& N cancer follow-up clinics with particular focus on the elderly (75 years or older). The PCI- HN data were obtained from patients attending follow-up clinics between August 2007 and January 2013. The groups for comparison were: <55 ( n = 105), 55-64 ( n = 170), 65-69 ( n = 64), 70-74 ( n = 68), and ≥75 ( n = 76), the median in this last group of 79.1 years. Regarding quality of life ( QoL) on first completing the PCI the elderly reported better anxiety and mood, higher social-emotional subscale scores and better overall QoL. On the PCI, being elderly did not seem to affect the total numbers of items selected, though fewer items were selected from the psychological, emotional and spiritual well-being domain, and in particular the item about fear of recurrence. Dentist and surgeon were the two health professionals most often selected that patients wished to see or be referred on to. It is possible to recognise concerns in routine clinical care, thus allowing the opportunity for intervention and support to improve the outcome for the elderly. [ABSTRACT FROM AUTHOR]

This paper presents a population-based retrospective cohort study to identify the differences in secondary primary cancer ( SPC) among hypopharyngeal, laryngeal, and other sites of head and neck cancer ( HNC). Data were collected from the Taiwan National Health Insurance Research Database ( NHIRD) for the period 1979-2010. The study cohort comprised 5914 newly diagnosed hypopharyngeal and laryngeal patients from the registry of the Catastrophic Illness Patients Database ( CIPD). The comparison cohort comprised 5914 patients with other sites of HNC. We used a multivariate Cox proportional-hazards regression model to assess the risk of developing SPC. The incidence of SPC in the study cohort was 68% higher compared with the comparison cohort (23.9 vs. 14.2 per 1000 person-years, Incident Rate Ratio = 1.68). The study cohort had a higher adjusted hazard ratio ( HR) in oesophageal cancer ( HR = 3.47) and lung cancer ( HR = 1.89). The difference in SPC incidence between the study and comparison cohort was significant. [ABSTRACT FROM AUTHOR]

LOO S.W., GEROPANTAS K., TASIGIANNOPOULOS Z., MARTIN C. & ROQUES T.W. (2013) European Journal of Cancer Care 22, 32-40 Feasibility and tolerance of sequential chemoradiotherapy in squamous cell carcinoma of the head and neck This paper evaluates the feasibility and tolerance of sequential chemoradiotherapy in patients with squamous cell carcinoma of the head and neck and ascertains whether the use of induction chemotherapy compromises delivery of subsequent radiotherapy with or without concurrent chemotherapy. We also compared sequential chemoradiotherapy treatment adherence between the elderly and younger patients with squamous cell carcinoma of the head and neck. One hundred and ninety-four patients with head and neck squamous cell carcinoma who received induction chemotherapy with cisplatin and 5-fluorouracil were included in this study. Treatment-related death rate from induction chemotherapy was 1.5%. One hundred and ninety-one patients (98.5%) proceeded to radical radiotherapy, with 90.1% also receiving planned concomitant chemotherapy. One hundred and seventy-eight patients (93.2%) completed radiotherapy with no prolongation of the treatment duration. There were no statistical differences in sequential chemoradiotherapy treatment adherence and tolerance between the elderly and younger patients apart from the proportion who required hospitalisation during radiotherapy. Induction chemotherapy in head and neck squamous cell carcinoma does not compromise delivery of definitive radiotherapy with or without concurrent chemotherapy. Elderly patients with head and neck squamous cell carcinoma are able to tolerate aggressive treatments such as sequential chemoradiotherapy. Treatment 'deintensification' based solely on chronological age is not recommended. [ABSTRACT FROM AUTHOR]

Objective: The web‐based application Oncokompas was developed to support cancer patients to self‐manage their symptoms. This qualitative study was conducted to obtain insight in patients' self‐management strategies to cope with cancer and their experiences with Oncokompas as a fully automated behavioural intervention technology. Methods: Data were collected from semi‐structured interviews with 22 participants (10 head and neck cancer survivors and 12 incurably ill patients). Interview questions were about self‐management strategies and experiences with Oncokompas. Interviews were audio‐recorded, transcribed verbatim and analysed using thematic analysis. Results: Participants applied several self‐management strategies, among which trying to stay in control and make the best of their situation. They described Oncokompas' added value: being able to monitor symptoms and having access to a personal online library. Main reasons for not using Oncokompas were concentration problems, lack of time or having technical issues. Recommendations were made for further development of Oncokompas, relating to its content, technical and functional aspects. Conclusions: Survivors and incurably ill patients use various self‐management strategies to cope with cancer. The objectives of self‐management interventions as Oncokompas correspond well with these strategies: taking a certain responsibility for your well‐being and being in charge of your life as long as possible by obtaining automated information (24/7) on symptoms and tailored supportive care options. [ABSTRACT FROM AUTHOR]

Objectives: We evaluated the quality of care for patients with squamous cell carcinoma (SCC) of the oral cavity, oropharynx, hypopharynx or larynx in Belgium. Methods: Data of the Belgian Cancer Registry were coupled with health insurance data and hospital discharge data. Quality of care and the association with hospital volume were evaluated based on six quality indicators. Results: Half of the patients were treated with primary radiotherapy, with or without systemic therapy (49.7%) and 38.1% with surgery, with or without (neo)adjuvant therapy. Single‐modality treatment was provided to 78.1% of early‐disease patients. Of the patients with cN0 disease, 56.4% underwent neck dissection. Postoperative radiotherapy was completed timely in 48.5% of patients. Concomitant chemotherapy was administered to 58.2% of patients <70 years with locally advanced disease. Imaging of the neck after radiotherapy was performed appropriately in 32.7% of patients. Variability between centres was considerable. No clear relationship between hospital volume and results of the individual QIs was observed. Conclusions: Results show that for the measured QIs, targets are not met and variability between centres is considerable. Through individual feedback, centres are motivated to improve the quality of care for head and neck cancer patients in Belgium. [ABSTRACT FROM AUTHOR]

Objectives: The diagnosis and effects of complicated cancer treatment often cause psychophysical distress in the patient. The psychosocial concerns that arise because of the diagnosis and treatment‐seeking process of cancer are often overlooked. Considering the significance, the study attempts to understand the effect of treatment‐seeking processes on the psychosocial health of tobacco‐related cancer (TRC) patients. Methods: Using explanatory sequential design, 100 participants were interviewed in the quantitative phase of the study, followed by in‐depth interviews of 11 participants who had diverse treatment‐seeking experiences. Hindi version of the Self‐Reporting Questionnaire 20 (SRQ‐20) was used to examine the TRC patient's common mental disorders (CMD). Findings: A high incidence of CMD (73%) was reported by cancer patients in the Barak Valley of Assam. TRC patient's socio‐demographic characteristics, health attributions and general existential questions regarding the diagnosis of cancer were found to influence their mental health. Also, it was revealed that informational supports were negatively correlated with the CMD of the patient. Conclusions: The study suggested for strengthening social support and networks at different levels to improve patient's psychosocial health. Emphasising on building small social institutions, it advocates for engaging practitioners of modern and alternative medicine to comprehensively address patient's psychosomatic needs. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the relationship between dysphagia and sarcopenia in patients with head and neck cancer (HNC). Methods: A cross‐sectional, prospective study, sample by convenience, including men with HNC during their initial oncologic evaluation. Patients answered questionnaires (demographic data, lifestyle habits, disease characteristics and the Short International Physical Activity Questionnaire). Swallowing capacity, bioelectrical impedance (BIA), handgrip strength (HGS) and physical performance test (Timed Up and Go test) were evaluated. Sarcopenia was diagnosed following the European Working Group on Sarcopenia and Foundation for the National Institute of Health criterion. Results: 71 men, elderly (66.9 ± 6.25 years) and adults (53.17 ± 3.66 years), were divided into the dysphagic group (DG, 44) and the non‐dysphagic group (NDG, 27). The DG presented lower body mass index (BMI), lower skeletal muscle mass and a higher number of sarcopenic individuals than the NDG (p < 0.05). The degree of dysphagia was associated with weight loss (p = 0.006) but not with sarcopenia (p = 0.084) in the DG. The multivariate analysis showed that age, percentage of weight loss and BMI interfered with pre‐sarcopenia, and only age influenced sarcopenia (p < 0.005). Conclusion: Patients with dysphagia had a high prevalence of sarcopenia in the pre‐treatment phase, related to age. [ABSTRACT FROM AUTHOR]

Objective: Head and neck cancer (HNC) is the sixth leading cancer worldwide with approximately 600,000 new cases per year. Several studies suggest that HNC survivors may have an increased risk of developing second primary cancers (SPCs). A systematic review and meta‐analysis was performed aiming to quantify the overall and site‐specific risk of metachronous SPCs in HNC survivors. Methods: PubMed, Web of Science and Scopus were searched to identify studies published until October 2019. Studies investigating the standardised incidence ratio (SIR) of metachronous SPC were included. A random‐effects meta‐analysis was performed to calculate the overall and site‐specific SIRs. Newcastle–Ottawa Scale was used to assess the study's quality. Heterogeneity was quantified using the I2 statistics and explored using meta‐regression. Results: Twenty‐six studies were included in the systematic review. Studies differed by the definition of metachronous SPC used. For the meta‐analyses, the studies were grouped according to these definitions. In the three groups, the overall risk of metachronous SPC was increased. The highest SPC risk was for oropharynx, oesophagus and lung. Conclusions: Head and neck cancer survivors are at increased overall risk of metachronous SPCs. The canonical upper aerodigestive sites, HNLE (head and neck, oesophagus and lung), were the SPC sites with the highest risk. Implication for Cancer Survivors: Our results emphasise the importance of targeted surveillance strategies aimed at early detection and tertiary preventive interventions. [ABSTRACT FROM AUTHOR]

Objective: To describe the experiences of South African patients living with head and neck cancer. Methods: We used a qualitative descriptive design and conducted unstructured interviews with 18 (n = 18) purposive selected participants. Data saturation determined the sample size. Qualitative content analysis was used to analyse the data. Results: The majority of the sample were Black males; on average, 50.8 years (SD ± 13.6) old. Two themes and eight subthemes arose from the data. The themes were living with the consequences of the illness and treatment, and coping with a changed life. The lives the participants knew before becoming sick changed and became a living hell; pain was a major problem as was eating and for some, communicating. The participants were stigmatised, ridiculed and rejected which added to their suffering. Receiving support from family and friends and their faith in God assisted them to cope with their changed lives. Conclusion: Our study poses various challenges to clinical practice. Pain management is of the utmost importance; the nutritional status of these patients should be monitored and best practices in terms of management applied. Raising awareness of cancer and its complications could improve knowledge and decrease blame, stigmatisation and rejection and improve patient outcomes. [ABSTRACT FROM AUTHOR]

The efficacy of traditional follow‐up care is being challenged, as cancer survivors' supportive and psychological needs are often neither identified, nor addressed. This study's aim was to develop a holistic surgical follow‐up clinic for oral and oropharyngeal cancer patients were participants completed a disease‐specific health‐related quality of life tool (UWQOLv4) and item prompt list (Patient Concern Inventory) on a touchscreen computer. Information generated was used to focus the consultation on patient's identified needs and concerns. By means of a prospective non‐randomised, pre‐test post‐test design, this follow‐up clinic was evaluated using the patient enablement instrument (PEI) and patient content checklist (PCC). Feasibility was explored from the patient perspective (satisfaction survey) and clinician perspective (qualitative interview). Forty‐four consecutive patients were recruited. Findings demonstrating five of the eight topics (overall QOL, emotions, head and neck symptoms, side‐effects of treatment, chronic non‐specific) on PCC were discussed more frequently, but changes were not statistically significant. The PEI highlighted a trend towards perceived improvement in four of the six items. Using touchscreen computers to aid communication during routine follow‐up was reported as both feasible and beneficial by patients and clinicians. Providing a patient‐focused follow‐up consultation can facilitate the identification of unmet needs, permitting timely and appropriate intervention being initiated. [ABSTRACT FROM AUTHOR]

This systematic review and meta‐analysis aimed to evaluate the effectiveness of psychological interventions in improving quality of life for head and neck cancer patients. Five databases were systematically searched in July 2016. Studies were included if they reported original empirical data from intervention studies utilising psychological approaches (excluding psychoeducational‐only interventions) and provided data on quality of life outcomes. Six studies, involving 185 participants, fulfilled eligibility criteria. Study designs included a case study, single‐group designs, non‐randomised controlled trials and one randomised controlled trial. Meta‐analysis of two studies did not provide support for the effectiveness of psychological intervention improving total quality of life scores (or subscales) compared to control groups at end of intervention. Intervention studies evaluating psychological interventions for patients with head and neck cancer have produced insufficient data to support their effectiveness for improving quality of life. This review further highlights the limited evidence base within this area. Existing studies are based on small samples and are inconsistent regarding: intervention type, duration and intensity; follow‐up measurement periods; and methodological quality. Further research, addressing these limitations, is required for more definitive conclusions to be drawn about the effectiveness of psychological interventions with this population. [ABSTRACT FROM AUTHOR]

Fear of cancer recurrence (FCR) is common among individuals treated for cancer. Explorations of how this fear is expressed within an oncology setting and responded to are currently lacking. The aim was to investigate how head and neck cancer survivors in follow‐up consultations express FCR, investigate how a healthcare professional addresses recurrence fears, and examine how survivors experience this interaction. We recorded the follow‐up consultations of those participants who have reported FCR as a concern on the Patient Concerns Inventory. We also conducted a follow‐up phone interview with the participants. We analysed the transcripts using thematic analysis. Five men and six women were recruited, aged 55–87 (mean age = 64). Follow‐up consultation analyses revealed that the consultant used “normalising FCR,” “reassurance,” and “offer of referral to a counsellor.” Interviews revealed themes around how they coped with FCR, relevance of personal history on FCR, and the impact of feeling gratitude towards the consultant on expression of FCR. Analyses indicate that patients may feel reluctant to raise their FCR with their clinician for fear of appearing “ungrateful” or of damaging a relationship that is held in high esteem. Findings indicate the initiation of FCR with patients can be beneficial for patient support. [ABSTRACT FROM AUTHOR]

The experiences of disease and treatment for patients diagnosed with head and neck cancer (H& NC) are known to be important indicators of the quality of care but are represented poorly in the literature. Survival is a major outcome measure to which health-related quality of life ( HRQoL) adds detail but outcomes are not fully representative of the patients' experiences because quality of care and reality of treatment are overlooked. This study explored the HRQoL, quality of care and reality of treatment themes using a mixed-methods approach, Q Methodology. In total, 18 participants who were at least 12 months post-diagnosis rank-ordered 45 prepared statements to reflect their own experiences of H& NC. After the statements had been sorted, the participants reviewed the order in an interview to clarify experiences. The statements become a way of facilitating the discussion because the participant can explain the position of specific statements that are notable for them. The ranking was factor-analysed case-wise and five factors provided the best conceptual fit: meaning and attachment to illness; overwhelmed by the cancer; surviving or not; change and recovery; and keep control for the greater good of others. The findings suggest there are distinct ways that H& NC patients experience the disease and its treatment. The concept of the experience being different and defined for individuals has practical implications at a clinical level and is a way of ensuring care is truly patient-centred. [ABSTRACT FROM AUTHOR]

We aimed to investigate the levels of anxiety, depression, satisfaction with information provision and cancer-related knowledge in partners of head and neck cancer ( HNC) patients receiving a Multimode Comprehensive Tailored Information Package ( MCTIP). A non-randomised, controlled trial was conducted with partners of HNC patients recruited at two academic hospitals in Montreal. The Test participants received the MCTIP, while the Control participants received information in an ad hoc manner. All participants were evaluated using the Hospital Anxiety and Depression Scale ( HADS), Satisfaction with Cancer Information Profile and a cancer knowledge questionnaire at baseline, and 3 and 6 months later. Data were analysed using descriptive statistics, t-test and chi-square test, and mixed model analysis to test the impact of the intervention. A total of 31 partners of HNC patients participated in this study and completed all the evaluations. The partners in the Test group experienced significantly lower levels of anxiety ( P = 0.001) and depression ( P = 0.003) symptoms and were more satisfied ( P = 0.002) with cancer information provided than partners in the Control group. Providing tailored information seems to have positive outcomes regarding anxiety, depression, and satisfaction in partners of HNC patients. Larger randomised studies are warranted to validate these effects. [ABSTRACT FROM AUTHOR]

People with head and neck cancer ( HNC) experience elevated symptom toxicity and co-morbidity as a result of treatment, which is associated with poorer psychosocial and quality-of-life (QoL) outcomes. This Phase I study examined whether an individualised mindfulness-based stress reduction ( IMBSR) programme could be successfully used with HNC patients undergoing curative treatment. Primary aims were to explore feasibility, compliance, acceptability and fidelity. Secondary aims were to determine whether (1) participation in the intervention was associated with changes in post-intervention mindfulness and (2) post-intervention mindfulness was associated with post-intervention distress and QoL. Nineteen HNC patients participated in a seven-session IMBSR programme with pre- and post-test outcome measures of psychological distress, depression, anxiety and QoL. Primary aims were assessed by therapists or participants. Mindfulness, distress and QoL were assessed using self-report questionnaires at pre- and post-intervention. Longer time spent meditating daily was associated with higher post-intervention mindfulness. After controlling for pre-intervention mindfulness, there was an association between higher post-intervention mindfulness and lower psychological distress and higher total, social and emotional QoL. This study offers important preliminary evidence than an IMBSR intervention can be administered to HNC patients during active cancer treatment. A randomised controlled trial is warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

Patterns of follow-up and survivorship care are changing in response to growing numbers of cancer survivors and an increasing recognition that traditional models are unsustainable and result in unmet needs. Clinicians have shown reluctance in changing conventional follow-up practices for patients with head and neck cancer. This study aimed to explore nurses' and allied health professionals' views and practices in relation to follow-up, holistic needs assessment and survivorship care in this patient group. An online survey of members of the British Association of Head and Neck Oncology Nurses was undertaken. The response rate was 43% (74 of 174). Findings revealed a range of existing models of follow-up, rehabilitation and support for people with head and neck cancer across the UK. Specialist staff were open to new models of care and to more responsibility, with adequate training and supervision. There were some gaps in the provision of comprehensive survivorship care and some specific areas of practice in which nurses lacked confidence, knowledge and skills, such as managing medications and complex symptoms. Further research is needed to develop and evaluate effective models of follow-up and support for a growing population of head and neck cancer survivors who have diverse and complex needs. [ABSTRACT FROM AUTHOR]

The aim of this study was to identify the distress, unmet needs and concerns of head and neck cancer ( HNC) survivors in the first 5 years after treatment. Two hundred and eighty HNC survivors from three Scottish health boards responded to a cross-sectional postal survey in 2011. Questionnaires included the Distress Thermometer, Patient Concerns Inventory (PCI) and an adapted version of the PCI to measure unmet needs. One-third of the survivors had moderate or severe levels of distress, and 74% had at least one unmet need. The most common concerns and unmet needs included oral and eating problems, fear of recurrence and fatigue. Multivariate analysis revealed that being younger, out of work (not retired), ever having had a feeding tube fitted, having a greater number of comorbidities and living alone were associated with higher levels of distress, concerns and unmet needs. The diversity of concerns and unmet needs identified in this study highlights the importance of holistic needs assessment as part of follow-up care for HNC survivors with tailoring of support for particular concerns. Specific information resources and self-management strategies are required to help HNC survivors with the practical and functional consequences of HNC treatment. [ABSTRACT FROM AUTHOR]

Head and neck ( H& N) cancer is mainly a cancer of the elderly; however, the implementation of comprehensive geriatric assessment ( CGA) to quantify functional age in these patients has not yet been studied. We evaluated the diagnostic performance of screening tools [ Vulnerable Elders Survey-13 ( VES-13), G8 and the Combined Screening Tool ' VES-13 + (17- G8)' or CST], the feasibility of serial CGA, and correlations with health-related quality of life evolution [ HRQOL; European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires ( EORTC QLQ)- C30 and - HN35] during therapy in hundred patients, aged ≥65 years, with primary H& N cancer undergoing curative radio(chemo)therapy. Respectively 36.8%, 69.0%, 62.1% and 71.3% were defined vulnerable according to VES-13, G8, CST and CGA at week 0, mostly due to presence of severe grade co-morbidities, difficulties in community functioning and nutritional problems. At week 4, significantly more patients were identified vulnerable due to nutritional, functional and emotional deterioration. The CST did not achieve the predefined proportion necessary for validation. Vulnerable patients reported lower function and higher symptom HRQOL scores as compared with fit patients. A comparable deterioration in HRQOL was observed in both groups through therapy. In conclusion, G8 remains the screening tool of choice. Serial CGA identifies the evolution of multidimensional health problems and HRQOL conditions during therapy with potential to guide individualised supportive care. [ABSTRACT FROM AUTHOR]

Head and neck cancer patients are at high risk of malnutrition and its complications and therefore often undergo non-oral nasogastric or percutaneous endoscopic gastrostomy (PEG) nutrition support. However, there is little evidence that either approach is effective in this group. While one possible explanation for these findings relates to the relationship between artificial tube feeding and poor quality of life, there is little research that examines the patient's subjective experience of nutrition support. This study investigated the experiences of PEG tube feeding in head and neck cancer patients undergoing radical treatment. Conventional Q-methodology was used with 15 head and neck cancer patients, who rank-ordered 36 statements according to the extent to which these reflected their experiences of PEG tube feeding. The sorted statements were factor-analysed case-wise to provide clusters of similar experiences. Three perspectives emerged. Factor 1, labelled 'Constructive cognitive appraisal', focused around positive adaptation to, and acceptance of, PEG feeding. Factor 2, labelled 'Cognitive-affective dissonance', reflected ambivalence between cognitive acceptance and affective rejection of the PEG tube. Factor 3, labelled 'Emotion-focused appraisal', was characterised by tube-focused anxiety and fear. The findings broadly confirm Levanthal et al.'s Self-Regulatory Model of coping and support the need for genuine and individualised patient-centred nutritional care. [ABSTRACT FROM AUTHOR]

Objective: Extensive research has documented the negative nutritional impact of head neck cancer (HNC) treatment, but few studies have addressed the patients' experiences. The purpose of this study was to describe how patients with HNC experience the nutritional situation and perceive nutritional support from diagnosis to the post‐treatment phase. Methods: Patients with HNC were recruited from a randomised pilot study. Individual interviews were conducted after radiotherapy with 10 participants aged 49 – 70 years and analysed by qualitative content analysis. Results: Undergoing surgery was experienced as a poor nutritional starting point for the upcoming radiotherapy. During radiotherapy, increasing side effects made the participants customise their meals to improve food intake. About halfway through radiotherapy, virtually no food intake was experienced and hospital admissions and initiations of tube‐feeding occurred in this period. Oral nutritional supplements were recommended for all, but eventually became unbearable to ingest. When radiotherapy was finally completed, the participants felt discouraged about the persistent side effects preventing them from resume eating. The participants missed tailored information about development of side effects and involvement of a dietitian when reflecting on the treatment‐period. Conclusion: The comprehensive nutritional problems experienced by patients with HNC require early nutritional assessments and improved individually tailored nutritional support. [ABSTRACT FROM AUTHOR]

Surgery is the treatment of choice in most head and neck cancers. Very often, the surgery is radical with high impact on the psychosocial, functional and aesthetic fields. The aim of this study is to gain a deeper understanding of the patient's, clinician's and key informant's point of view when surgery is proposed, to improve the quality of pathways in terms of patients' practical, psychological and relational needs. We followed a Grounded Theory approach with semi‐structured interviews. Seventeen participants (six patients, nine healthcare professionals and two volunteers) were interviewed immediately before surgery. The study generated a process of "persuading the patient of an obligation" as the core category. The other principal categories that emerged highlighted the patients' doubts and fears regarding the surgery consequences and, in parallel, strategies employed by the healthcare professionals to rebut hindering issues impeding surgery. In particular, healthcare professionals involved patients in an affiliation process through simplified communication to sustain the choice of surgery; the family plays a supportive role in this process. The interplay between the organisational process and patients' experience results in "I will let you convince me" at the end of the decision‐making process, where the main aim was to save and be saved. [ABSTRACT FROM AUTHOR]

Objective: To determine whether marital status independently predicts survival in a head and neck cancer (HNC) survivor population. Methods: In this retrospective cohort study, we analysed data from 460 adult patients (59.31 ± 11.42) years diagnosed with HNC at an academic tertiary referral centre between 1997 and 2012. Cox proportional hazards model estimated the effect of marital status on survival. Results: Our study had 73% men, and 82.2% were Whites. We found an association between marital status and HNC survival. Unmarried HNC patients had a 66% increase in hazard of death compared to married patients (aHR = 1.66, 95% CI = 1.23–2.23). This was after controlling for sociodemographic variables (age, race, sex and health insurance status), social habits (tobacco and alcohol), primary anatomical subsite (oral cavity, oropharyngeal, laryngeal and others), stage at presentation (early vs. late stage) and treatment modality (surgery, surgery with adjuvant therapies, other single modality therapy and palliative care). Conclusions: Being married confers survival advantage for HNC survivors. Our finding underscores the need to recognise this aspect of survivorship. Social support should be considered part of standard care for managing HNC. There may also be need to develop other support mechanisms, especially for unmarried HNC survivors. [ABSTRACT FROM AUTHOR]

The aim was to conduct a systematic review and a meta‐synthesis of primary qualitative studies exploring experiences of head and neck cancer patients (HNC) undergoing radio and/or chemotherapy, in order to provide a better understanding of this phenomenon and supply new directions for care and clinical practice. Six databases were systematically searched, and 13 studies were included. The meta‐synthesis methodology was adopted to conceptualise the way in which patients lived their cancer journey and the impact of treatments on their daily life. Four themes embracing various aspects of HNC patients' experiences were identified: (a) self‐body image and perceived quality of life; (b) experiences and treatment of symptoms; (c) cancer journey; and (d) the relationship with health professionals. The finding demonstrates the importance of acknowledging that treatment sequelae and patients' daily issues do not appear, develop and affect people's lives in isolation and should be considered and analysed as a whole within the social and cultural context of patients' lives. Further research is needed to explore the treatment experience of HNC patients throughout their cancer journey with a more holistic approach that involves health professionals, caregivers and other family members and peers in the community. [ABSTRACT FROM AUTHOR]