(Press-News.org) Most patients do not have ongoing speaking or swallowing difficulties following combined chemotherapy and radiation treatment for advanced head or neck cancer, but several factors may be associated with worse outcomes in these functions, according to a report in the December issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.
"Speaking and swallowing deficits are experienced by many survivors of primary cancers of the head and neck," the authors write as background information in the article. "Although it is often difficult to separate the individual contributions of the tumor and the treatment to these deficits, several studies have shown that, when compared with organ-removal surgery, chemoradiotherapy with or without organ preservation surgery can minimize post-treatment speech and swallowing deficits while maintaining excellent tumor control."
Kent W. Mouw, M.D., then of the University of Chicago and now of Brigham and Women's Hospital, Boston, and colleagues studied patients who were successfully treated with chemoradiotherapy for advanced head and neck cancer. An average of 34.8 months after completing treatment, 163 patients were assigned a speaking score of one through four and 166 patients were assigned a swallowing score of one through four at an average of 34.5 months after treatment, with increasing scores correlating with decreasing function.
Most patients (84.7 percent of those with speaking scores and 63.3 percent of those with swallowing scores) had no lasting difficulties and were assigned a score of one. Of 160 patients who had both swallowing and speaking scores, 96 had a score of one in each category.
Factors that were associated with worse speaking scores were being female, having a history of smoking, having a tumor in the hypopharynx (where the larynx and esophagus meet) or in the larynx, or having a tumor that did not respond to the initial dose of chemotherapy. Factors associated with worse swallowing scores included being older, having poor performance status (a measure of disability) before treatment and neck dissection (surgery to remove lymph nodes and surrounding tissue), with a trend toward worse scores in those with tumors in the hypopharynx and larynx.
The study involved a large enough group of patients to identify multiple factors correlating with speech and swallowing difficulties, the authors note. "However, one of the remarkable features of the data is that most of the patients experienced minimal residual speech or swallowing deficits," they write. "Although differences detected by more advanced modalities may exist between these patients and healthy subjects, it is encouraging to note that, when day-to-day activities are used as a metric, most patients experience a return to normal or near-normal function."
"Because advances in therapy have led to improved survival in these patients, understanding and controlling adverse effects of treatment should continue to be an active area of investigation," the authors conclude.
INFORMATION:
(Arch Otolaryngol Head Neck Surg. 2010;136[12]:1226-1234. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported by the Robert and Valda Svendsen Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
To contact corresponding author Joseph K. Salama, M.D., call Michelle Gailiun at 919-660-1306 or e-mail michelle.gailiun@duke.edu.
For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.
Most patients can speak and swallow after combination treatment for head and neck cancer
2010-12-21
ELSE PRESS RELEASES FROM THIS DATE:
Outcomes after recurrence of oral cancer vary by timing, site
2010-12-21
Patients who have recurrence of oral squamous cell carcinoma tend to do worse if the new cancer appears at the same site early or if it appears in the lymph nodes six months or longer after initial treatment, according to a report in the December issue of Archives of Otolaryngology–Head & Neck Surgery, one of the JAMA/Archives journals.
Treating recurrences of oral squamous cell carcinoma (cancer in the thin, flat cells that line the lips and mouth) involves balancing the risk of complications against the potential benefit to the patient in terms of survival or controlling ...
Study finds injectable and oral birth control do not adversely affect glucose and insulin levels
2010-12-21
GALVESTON, December 17, 2010 – Fasting glucose and insulin levels remain within normal range for women using injectable or oral contraception, with only slight increases among women using depot medroxyprogesterone acetate (DMPA), commonly known as the birth control shot, according to new research from the University of Texas Medical Branch (UTMB Health) in Galveston.
The study, published in the January 2011 issue of Obstetrics and Gynecology and conducted over three years, is the largest to measure fasting glucose and insulin levels among women using DMPA, oral (desogestrel) ...
Factors linked to speech/swallowing problems after treatment for head and neck cancers
2010-12-21
DURHAM, NC – Most patients with locally advanced head and neck cancers who successfully complete treatment with chemotherapy and radiation manage to do so without losing the ability to speak clearly and swallow comfortably, according to researchers at the Duke Cancer Institute.
"This is good news," said Joseph K. Salama, MD, an assistant professor of radiation oncology at Duke and the corresponding author of the study. "I hope it brings some comfort to newly-diagnosed patients who are understandably worried about what long-term effects treatment might involve."
The ...
New research shows virus previously linked to chronic fatigue syndrome is a lab contaminant
2010-12-21
A virus previously thought to be associated with chronic fatigue syndrome is not the cause of the disease, a detailed study has shown. The research shows that cell samples used in previous research were contaminated with the virus identified as XMRV and that XMRV is present in the mouse genome.
XMRV was first linked to chronic fatigue syndrome – also known as myalgic encephalomyelitis (ME) – in a study published in October 2009, where blood samples from chronic fatigue syndrome patients were found to have traces of the virus. XMRV had also been identified previously in ...
Without intervention, Mariana crow to become extinct in 75 years
2010-12-21
Researchers from the University of Washington say the Mariana crow, a forest crow living on Rota Island in the western Pacific Ocean, will go extinct in 75 years.
The extinction could happen almost twice as soon as previously believed.
The crow's extinction can be prevented with a bird management program that focuses on helping fledgling birds reach their first birthday, said James Ha, UW research associate professor in psychology.
Ha examined survival rates in 97 Mariana crows – Corvus kubaryi – that had been tracked between 1990 and 2010 by researchers. He found ...
Finnish researchers find a compound that prevents the growth of prostate cancer cells
2010-12-21
Evidence pointing to the effects of monensin emerged in a project investigating the effects of nearly 5,000 drugs and micromolecules on the growth of prostate cancer cells. The project involved most of the drugs on the market today. Researchers found that small amounts of compounds – disulfiram (Antabus), thiram, tricostatin A, and monensin – can prevent the growth of prostate cancer cells without significant effects on the growth of the normal human prostate epithelial cells.
Further studies revealed that monensin caused prostate cancer cell death by reducing the amount ...
Subsidies have no effect on Spanish cinema productivity
2010-12-21
Awards have an impact on Spanish movie productivity, since they increase internal and external distribution demand, but subsidies have no effect whatsoever on the productivity of the Spanish film industry. This is the conclusion of researchers at the University of Granada (UGR), who have studied the production of films in Spain.
"Awards increase the amount of films produced by increasing productivity. In other words film industry workers and companies are more productive and efficient. However, we did not detect that subsidies had any such effect on productivity", Henry ...
A possible cause -- and cure -- for genital cancer in horses?
2010-12-21
Horses are prone to develop genital cancer, especially as they grow older. Male horses are more commonly affected than mares but both sexes suffer from the condition, which is extremely difficult to treat and may result in the animals' death. Because of the similarity of the disease to human genital cancer it seemed possible that a similar agent might be responsible. Several human genital cancers, including cervical tumours, are known to be caused by a papillomavirus infection, so Brandt and her coworkers used genetic techniques to look for papillomavirus DNA in tissue ...
Study finds food in early life affects fertility
2010-12-21
The reproductive success of men and women is influenced by the food they receive at an early stage in life, according to new research by the University of Sheffield.
The research, which was published online this month (17 December 2010) in the journal Ecology, is the first study of its kind to show that early life food can have a serious influence on the life-long fertility of individuals.
The research team, led by Dr Ian Rickard from the Department of Animal and Plant Sciences at the University, used a combination of church record data on births in 18th century Finland ...
Muscle filaments make mechanical strain visible
2010-12-21
Plastics-based materials have been in use for decades. But manufacturers are facing a serious hurdle in their quest for new developments: Substantial influences of the microscopic material structure on mechanical material properties cannot be observed directly. The synthetic polymer molecules are simply too small for microscopic observation in mechanical experiments. A team of physicists led by professor Andreas Bausch of the Technische Universitaet Muenchen (TUM) has now developed a method that allows just these kinds of measurements. They present their results in Nature ...