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Additional file 1. SPIRIT Checklist

Additional file 1. SPIRIT checklist.

BACKGROUND: This study investigates cutoff scores for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions (EORTC QLQ-C30) and head and neck cancer-specific module (QLQ-H&N35) to identify patients with head and neck cancer who may require clinical attention.METHODS: Ninety-six patients with head and neck cancer completed the EORTC QLQ-C30/H&N35 and questions on supportive care needs. For all EORTC domains with the ability to discriminate between patients with and without unmet needs (area under the receiver operating characteristic curve [AUC] ≥0.70), the accuracy (eg, sensitivity and specificity) of potential cutoff scores were calculated.RESULTS: Cutoff scores (sensitivity ≥0.80 and specificity ≥0.60) of 90 (functioning domains) and 5 to 10 (symptom domains) were found on 7 of 28 continuous EORTC QLQ-C30/H&N35 domains. Borderline cutoff scores (sensitivity ≥0.70 and specificity ≥0.60 or sensitivity ≥0.80 and specificity ≥0.50) were found on 5 other domains.CONCLUSIONS: This study provided cutoff scores on the EORTC QLQ-C30 and H&N35 based on patients' perceptions of their needs for supportive care. Future research is needed on the replicability of these cutoff scores. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1493-E1500, 2016.

SPIRIT checklist. (PDF 167 kb)

SPIRIT checklist. (PDF 167 kb)

Sleep quality is essential for optimal health and wellbeing of each individual. Previous research hypothesized that a good night’s sleep plays important role not only in energy conservation and emotional regulation, but also in maintaining diurnal rhythm of hypothalamic-pituitary-adrenal (HPA) axis. Sleep disturbances, together with physical and psychological distress, are known to disrupt HPA-axis activity, causing changes in normal fluctuation of cortisol level. This may further affect physiological functions of cortisol, among which the most important is regulation of inflammatory response. Despite extensive research on sleep quality in cancer patients in general, similar research in head and neck cancer (HNC) patients is scarce. HNC patients often suffer from psychological distress and physical symptoms starting from cancer diagnosis throughout treatment completion. These symptoms often compromise their quality of life and may play a role in their sleep quality. However, the prevalence of different kind of sleep disturbances in HNC patients throughout different treatment phases is unclear. We did not know which group of HNC patients already have poor sleep quality before the start of cancer treatment. We also did not know how sleep quality of HNC patients evolves overtime, and which HNC patients tend to have persistent poor sleep quality. Last but not least, there is lack of research which highlights the complex relationship between sleep quality, pain, fatigue, psychological distress, HPA-axis, and inflammation in newly diagnosed HNC patients. This thesis aims to address these research gaps by investigating the epidemiology, trajectories, and associated factors of poor sleep quality in newly diagnosed HNC patients, taking into account personal, physical, psychological, and biological parameters. Findings in this thesis suggest that screening for poor sleep quality in HNC patients should be started shortly after HNC diagnosis. Moreover, it is important to first clearly define the type of sleep disturbance of interest and then choose a validated sleep screening instrument accordingly. A periodic sleep evaluation should be aimed to HNC patients who are more at risk of having persistent poor sleep quality. This group of patients may benefit from early intervention which simultaneously targets poor sleep quality and other (psychoneurological) symptoms. These findings also provide directions for future research, for example into the long-term effects of poor sleep quality, disruptions of HPA-axis and inflammatory dysregulations on HNC progression and survival.

There is substantial evidence that psychological problems occur in cancer patients. More insight is needed on the course of psychological problems over time from diagnosis to long-term follow-up, especially among high risk cancer populations such as head and neck cancer patients. Compared to distress, anxiety, depression, and fear of recurrence, evidence on the prevalence of adjustment disorder lags behind. Furthermore, previous studies suggest that psychological problems are associated with higher costs. However, detailed insight into economic consequences (e.g. healthcare use, informal care and work productivity) of psychological problems in cancer patients is still lacking. The main aim of this thesis is to provide insight in psychological problems among cancer patients from a clinical as well economic perspective. This thesis demonstrated that psychological problems in cancer patients are common and varies over time. Psychological problems were associated with several clinical and demographic factors. It was estimated that approximately two-third of patients with psychological problems accepts psychological treatment. Also, psychological problems were found to be associated with higher healthcare use and costs, delayed return to work, and more informal care use. The findings of this thesis indicate that reimbursement of psychological interventions for cancer patients with psychological problems have the potential to improve the quality of life of cancer patients, but also to reduce burden to the healthcare system by lowering healthcare and societal costs