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Background: Head and neck cancer (HNC) patients are prone to have a poor health-related quality of life after cancer treatment. This study investigated the effect of the nurse counselling and after intervention (NUCAI) on the health-related quality of life and depressive symptoms of HNC patients between 12 and 24 months after cancer treatment. Methods: Two hundred and five HNC patients were randomly allocated to NUCAI (N=103) or usual care (N=102). The 12-month nurse-led NUCAI is problem-focused and patient-driven and aims to help HNC patients manage with the physical, psychological and social consequences of their disease and its treatment. Health-related quality of life was evaluated with the EORTC QLQ-C30 and QLQ H&N35. Depressive symptoms were evaluated with the CES-D. Results: At 12 months the intervention group showed a significant (P

There is a rising incidence of patients presenting with advanced cancer in the head and neck region. Late presentation may be due to a delay in seeking medical attention, which is sometimes surprisingly long. The aim of the present prospective study was to investigate the association between patient delay and the psychological factors of optimism, health hardiness, overall defensive functioning, coping styles and psychological distress in 277 patients with cancer of the head and neck. Significant correlations were found between patient delay and the psychological factors. Twenty-six percent of the patients waited more than three months before seeking medical attention and they reported less optimism (P = 0.0001), less health hardiness (P = 0.008), less active coping (P = 0.019) and less seeking support as a coping style (P = 0.017) than patients presenting within three months. Excessive drinkers (5+ alcoholic drinks/day) tended to show more delay than patients who did not drink or were moderate drinkers (0-2 drinks/day) or moderate-heavy drinkers (3-4 drinks/day). Together, the psychological factors could explain 25% of the variance of patient delay in excessive drinkers compared with 21% and 6% in moderate-heavy drinkers and non-drinkers to moderate drinkers, respectively. These results suggest that psychological factors affect health-care seeking behaviour. Health education aimed at the risk group of excessive drinkers should take psychological factors into account that influence their health behaviour.

Elderly patients with head and neck cancer are less likely to receive standard treatment. This study assessed the influence that age, tumour characteristics, comorbidity, social support, depressive symptoms and quality of life have on treatment choice. One hundred and five patients between 45 and 60 years of age and 78 patients ofor =70 years of age with carcinoma of the oral cavity (stageor =II), oro- and hypopharynx (stageor =II) or larynx (stageor =III) completed a questionnaire on quality of life (EORTC QLQ-C30 and HN35), depressive symptoms (CES-D) and social support (RSS12-I). In the 45-60 age group, 89% received standard treatment, compared with 62% of theor =70 age group. A multivariate logistic regression analysis showed that the following factors predicted non-standard treatment: marital status (widowed), advanced tumour stage, comorbidity, less pain, considering the length of life less important than its quality and old age. This study showed that age itself independently influences treatment choice. However, it should be emphasised that the choice of a treatment should be based on a medical assessment and the patient's preferences, not on chronological age.

Summary This study was performed to assess whether subgroups of patients with signs and symptoms of craniomandibular dysfunction (CMD) and a control group of dental patients with and without signs of CMD can be characterized by psychosocial variables, and whether there is evidence of stress-induced muscle hyperactivity as a contributing factor in the development of signs and symptoms of CMD. A group of 127 care-seeking patients and a control group of 158 dental patients completed a Questionnaire Battery (QB) designed to measure external stressors, stress-related emotional reactions (anxiety and depression) and personal factors such as coping styles, health locus of control and personality. Patients with CMD with both a myogenous and an arthrogenous component reported more stress and stronger stress-related emotional reactions than patients with either an arthrogenous or a myogenous CMD. However, patients with arthrogenous CMD did not differ on psychosocial variables from patients with myogenous CMD. In contrast to expectations, controls with signs of CMD reported more stress than patients with CMD. Compared with controls, CMD-patients experienced less personal control over their health and they considered health to be determined by chance or fate. CMD-patients also reported to cope differently with stress than controls. Analyses of covariance showed that the results were not influenced by differences in age, sex or pain reported in the head, neck and/or shoulders. Results were interpreted with regard to the psychophysiological theory of the development of signs and symptoms of CMD as a consequence of the progression of stress-induced muscle hyperactivity. Differences between patients and controls in personal factors were interpreted with regard to treatment need for CMD.

The aim of this study was to identify which factors are related to specialist delay and to determine the length of the diagnostic pathway in head and neck cancer patients. Three hundred and six patients with a carcinoma of the larynx, pharynx or oral cavity were included in the study. Logistic regression analysis was used to identify risk factors for specialist delay. Large (T3-T4) tumors showed significantly less specialist delay than small (T1-T2) tumors (p=0.045, odds ratio [OR]=0.6). Pharyngeal (p=0.00, OR=0.2) and oral carcinomas (p=0.00, OR=0.2) had less specialist delay than glottic carcinomas. Hoarseness was associated with prolonged specialist delay (p=0.00, OR=5.9). Heavy drinking in combination with smoking (p=0.005, OR=0.3), a sore throat (p=0.02, OR=0.4) or having a lesion (p=0.03, OR=0.2) showed a shorter diagnostic period. The duration of the diagnostic process in a general hospital ranged from 0 to 570 days, with a median of 14 days. Only a small group of patients met the ideal management standards in our head and neck clinic. Although prolonged delay was associated with small (glottic) tumors, the diagnostic process takes a fairly long time. The results indicate that continued educational programs for professionals are warranted.

Health behavior plays an important role in the development, detection and course of cancer of the head and neck. Relevant health behavior includes prompt medical care seeking, and smoking and drinking cessation after diagnosis. This study examines the relationship between these health behaviors and health value and control beliefs, as well as psychological distress. Two hundred and sixty-four recently diagnosed head and neck cancer patients were interviewed about their health behavior, and they filled in a questionnaire on health beliefs and psychological distress. The results showed that one-quarter (25%) of the patients had waited more than 3 months before seeking medical care, 50% had continued to smoke and 80% had continued to drink after the diagnosis. The patients, particularly those who smoked and drank before diagnosis, reported lower levels of health value and perceived health competence than a general population sample with which they were compared. Patients who engaged in patient delay reported a lack of perceived health competence. Psychological distress and lack of perceived health competence were found to be more common among patients who continued to smoke. The implications of these findings are discussed with regard to interventions aimed at promoting these specific health behaviors.

Elderly patients with head and neck cancer are less likely to be treated surgically. However, little is known about surgical outcome and quality of life (QOL) in elderly patients after a major surgery. This prospective study compared the QOL and the surgical outcome of 54 elderly (> or =70 years) and 75 younger patients (45-60 years) with carcinoma of the oral cavity (stage > or = II), pharynx (stage > or = II) or larynx (stage > or = III). Before and 3 months after surgery, the patients completed questionnaires about QOL (EORTC QLQ-C30 and QLQ-H&N35) and depression (CES-D). Before treatment, elderly and younger patients did not differ in QOL. Three months after the treatment, both groups scored worse on most QOL aspects, but there were no significant differences between the elderly and the younger patients. Surgical and systemic complication rates were similar for both the groups. In conclusion, we found no significant differences in the complication rate and QOL aspects between surgically treated elderly and younger patients.

The aim of this prospective study was to describe quality of life (QoL) in patients with locally advanced prostate carcinoma treated with conventional radiotherapy and to evaluate the influence of adding regional or interstitial hyperthermia.All patients were irradiated using a CT-planned conventional three field technique, administering 70 Gy to prostate and vesicles. In two different phase I studies, hyperthermia was added to the radiotherapy. Twelve patients were treated with one interstitial hyperthermia treatment, lasting 60 min. Fourteen patients have been treated with five regional hyperthermia treatments, lasting 75 min each. In both hyperthermia studies, the body, bladder and rectum temperatures remained below safety limits. Patients treated with radiotherapy alone (n = 58) or combined with regional (n = 8) or interstitial hyperthermia (n = 12) completed the European Organization for Research and Treatment of Cancer (EORTC) core questionnaire (C30 + 3), the EORTC prostate cancer module (PR25) and the Rand 36 health survey before treatment and 1 and 6 months after completion of treatment. Analysis of Variance (ANOVA) for repeated measurements has been performed to describe the data.All patient groups were comparable concerning patient characteristics. No significant interaction or difference in QoL has been noticed between the two hyperthermia patient groups and the patient group without hyperthermia. Therefore, all groups were analysed together (n = 78) to detect QoL changes in time. A deterioration of QoL has been measured from baseline to 1 month after treatment. Fatigue, pain, urinary symptoms, bowel symptoms and financial difficulties increased significantly. Social, physical and role functioning worsened significantly. No differences in QoL were measured 6 months after treatment compared to the baseline measurement, except for a decrease in sexual activity.After radiotherapy with or without hyperthermia only a temporary deterioration of QoL occurs, concerning social, psychological and disease related symptoms. Additional hyperthermia does not seem to decrease QoL.

Background Previous studies indicate that the implantable cardioverter defibrillator (ICD) has a large impact on the quality of life of patients. The effects of having an ICD over longer periods of times has been less studied. Objective To assess the quality of life and well-being of cardiac arrest survivors who have received an implantable cardioverter defibrillator (ICD) or other treatment. Methods 168 patients were monitored for 1 year and completed four questionnaires. Results No differences were found between the two treatments regarding quality of life (except for pain, ICD patients perceived less pain) and well-being. A significant improvement in physical and social function, and in mental health was found in the first 6 months. Older patients (60 years or older) perceived less improvement in their health than younger patients. Women reported having poorer social function. The prevalence of anxiety and probable depression was high irrespective of the treatment received: anxiety and depressive symptoms did not change significantly between 1 and 12 months after discharge. Patients with higher anxiety scores experienced less improvement in health and patients with more depressive symptoms experienced poorer social function. Conclusions The prevalence of anxiety and probable depression was high in cardiac arrest survivors. Probable depression affected social function. Those patients who felt anxious experienced less health improvement. Quality of life and well-being were not affected by the type of treatment. We conclude that surviving an out-of-hospital cardiac arrest has a greater impact on patients than the treatment received. (Europace 2002; 4: 417–425)

The aim of this study was to describe prospectively quality of life and mood in patients with oral or oropharyngeal cancer treated with surgery±radiotherapy. Seventy-five patients completed the EORTC Core Questionnaire, the EORTC Head and Neck Cancer module and the Center for Epidemiologic Studies' Depression Scale before treatment and 6 and 12 months later. There was a significant deterioration of physical functioning, fatigue and almost all head and neck symptoms except pain, which improved. Patients with stage III/IV and patients receiving combined treatment had significantly worse physical symptoms compared to patients with stage I/II and patients treated with surgery only, respectively. Before and after treatment there was a high level of depressive symptomatology. However, after treatment a gradual improvement in emotional functioning occurred. Surgical treatment for oral or oropharyngeal cancer results in significant deterioration of physical functioning and symptoms during the first year, especially when combined with radiotherapy. Despite this, there is an improvement of emotional functioning after treatment, probably as a result of adaptation and coping processes.

To standardize clinical history taking, a comprehensive anamnestic questionnaire was developed (Screen). Screen includes questions about (i) pain, (ii) other symptoms of CMD, (iii) correlates of CMD, (iv) psychosocial factors, and (v) general health. Variables discriminating between subgroups of clinical cases and controls were described successively. This study was performed to assess whether subgroups of patients with signs and symptoms of craniomandibular dysfunction (CMD), and a control group of dental patients with and without signs and symptoms of CMD, can be characterized by differential report of signs and symptoms of CMD, as reported in Screen. Results indicate that Screen can be used to discriminate between (i) subgroups of subjects with signs or symptoms of CMD (both clinical cases and controls) and controls without signs or symptoms of CMD; (ii) subgroups of clinical cases and controls with signs and/or symptoms of CMD; and (iii) patients with CMD with mainly a myogenous component and patients with CMD with mainly an arthrogenous component. Differences between patients and controls are interpreted with regard to the correct classification of patients with CMD with mainly a myogenous component and patients with CMD with mainly an arthrogenous component, and with regard to the subjective treatment need for CMD. The results of logistic regression analyses indicate that subsets of items of Screen correctly classified up to 80% of patients with myogenous or arthrogenous CMD. Implications for further research were discussed.

Summary To standardize clinical history taking, a comprehensive anamnestic questionnaire was developed (Screen). Screen includes questions about: (i) pain, (ii) other symptoms of craniomandibular dysfuntion (CMD), (iii) correlates of CMD, (iv) pychosocial factors, and (v) general health. The current study focuses on variables in Screen concerning pain reported somewhere in the head, neck and/or shoulders. This study was performed to assess whether subgroups of patients with signs and symptoms of CMD and a control group of dental patients with and without signs and symptoms of CMD can be characterized by differences in areas reported to be painful, in quantitative and qualitative characteristics of pain, and in factors exacerbating pain. Results indicate that several characteristics of pain as measured in Screen can be used to discriminate between: (i) subgroups of subjects with signs and/or symptoms of CMD and controls without signs or symptoms of CMD, (ii) subgroups of clinical cases and controls with signs or symptoms of CMD, and (iii) patients with CMD with mainly a myogenous component and patients with CMD with mainly an arthrogenous component. The results of logistic regression analysis indicate that four adverbs describing pain correctly classified 75% of patients with CMD-myo and patients with CMD-arthro. Differences between patients and controls are interpreted with regard to the correct classification of patients with CMD with a mainly myogenous component and patients with CMD with a mainly arthrogenous component and the subjective treatment need for CMD. Implications for further research are discussed.