Pretreatment organ function in patients with advanced head and neck cancer: clinical outcome measures and patients' views

A comprehensive, multidimensional assessment was used, that included quality of life, swallowing, mouth opening, and weight changes. Fifty-five patients with stage III-IV disease were entered in this study prior to organ preserving (chemoradiation) treatment.All patients showed pretreatment abnormalities or problems, identified by one or more of the outcome measures. Most frequent problems concerned swallowing, pain, and weight loss. Interestingly, clinical outcome measures and patients' perception did no always concur. E.g. videofluoroscopy identified aspiration and laryngeal penetration in 18% of the patients, whereas only 7 patients (13%) perceived this as problematic; only 2 out of 7 patients with objective trismus actually perceived trismus.The assessment identified several problems already pre-treatment, in this patient population. A thorough assessment of both clinical measures and patients' views appears to be necessary to gain insight in all (perceived) pre-existing functional and quality of life problems.In recent years chemoradiation (CRT) has become an indispensable treatment modality for advanced head and neck cancer, improving local control and overall survival in all sites, except in the (stage IV) laryngeal cancers [1-3]. Unfortunately, CRT can have a detrimental effect on organ function, and on patients' quality of life [4]. But even before the onset of treatment patients may present with pain, impaired swallowing, aspiration, dietary restrictions and even with tube dependency, as well as trismus and loss of body weight, because the tumor may disrupt the normal anatomy and thus interfere with normal function [5-11]. Many studies have indeed investigated typical problems associated with head and neck cancer [12-16]. However, the majority of earlier research has focused on posttreatment dysfunction [4]. Moreover, the studies investigating problems associated with head and neck cancer tend to focus on only a limited set of functional aspects.A systemat