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Sexuality and sexual intimacy are important aspects of cancer survivorship. In head and neck cancer (HNC), concerns around sexual health, sexuality and sexual intimacy are infrequently raised or addressed in standard HNC consultations, either before embarking on treatment or during survivorship. The changing demographic of HNC patients, largely due to the increasing proportion of patients with human papillomavirus-associated oropharyngeal squamous cell carcinoma (HPVOPSCC), has driven renewed interest in some specific survivorship issues, including sexual behaviours and lifestyles, which may account for both the primary mode of HPV transmission and the younger and less comorbid population affected by this disease. While HNC survivors may have many complex needs in the short and longer term, some patients may prioritise preserving sexual function above other more HNC-specific issues, such as swallowing and xerostomia. Beyond HPVOPSCC, there is evidence to suggest that impairment of sexual health is a pervasive survivorship issue across all HNC cancer types, and this narrative review article highlights publications reporting quantitative assessments of sexual health outcomes in HNC patients. There are also limited studies evaluating whether current sexual health models of care are adequate for HNC patients or whether new or adapted models are needed. Future research will also need to define the impact of our treatments on the sexuality and sexual intimacy concerns of specific HNC cohorts with more granularity to enhance pre- and post-treatment counselling., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The Charlson Comorbidity Index (CCI) is a highly cited and well established tool for measuring comorbidity in clinical research, but there are problems with its use in practice. Like most comorbidity summary measures, the CCI was developed to adjust for prognostic comorbidities in statistical models, particularly those exploring associations between a risk of death or survival time and other patient-related and disease-related factors. Despite this, the CCI is often used in cancer research to measure all comorbidity, or as a multimorbidity measure, and CCI scores are often used to assess the prognostic importance of multiple health conditions. In the latter case, it is not at all surprising that researchers report a significant association between CCI scores and a risk of death or survival times because CCI scores provide a summary of the presence or absence of a set of prognostic comorbidities. Advances in multimorbidity research require specific attention to the methods used to develop relevant indices. Published literature on the association between the comorbidity and risk of death or survival time should be interpreted with caution, especially if the CCI was used to provide a measure of comorbidities., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: Knowledge of factors associated with intervention non-adherence may provide insights into the clinical utility of non-pharmacologic interventions., Methods: This study compared complete and incomplete adherers to two separate components of a novel intervention package for women undergoing curative intent radiotherapy for gynaecological cancer on socio-demographic, clinical and pre-radiotherapy patient-reported outcomes data., Results: Adherence to the tailored specialist nurse consultations was satisfactory (71% participated in all available sessions, 19% participated in all but one). Adherence to the telephone peer support sessions was less satisfactory (47% participated in all available sessions, 24% participated in all but one session). Complete adherers to the peer sessions reported significantly lower levels of psychological distress and significantly higher levels of physical, emotional and functional wellbeing before radiotherapy. No other statistically significant differences were observed between complete and incomplete adherers to the nurse- or peer-led sessions., Conclusion: Women's ability or motivation to engage with peer support may be influenced by their health and psychological status. Further, the extent of intervention non-adherence to the peer-led component may have compromised the assessment of its efficacy., Practice Implications: Peer support may be less acceptable or appropriate for women with more complex care needs. Such women may prefer specialised care from trained professionals., (Copyright © 2021. Published by Elsevier B.V.)

Objective: Healthcare experiences, quality of life and psychosocial needs of patients with Neuroendocrine tumours (NETs) will be assessed to identify differences between NET sub-groups and inform the design of supportive care services., Methods: This study constitutes phase one of a three-phase mixed-methods multi-site study with NET patients (n = 123). Demographic, clinical and patient reported outcome questionnaire data was collected., Results: No differences in patient reported outcomes were found beyond symptoms of diarrhoea and flushing between NET sub-groups. For combined NET patients, the majority reported negative experiences in their understanding of the explanation of what was wrong with them (67%); receiving written information about their cancer (69%), their family/carer receiving all the information required to care for them (61%); and the usefulness of information about NETs online (66%). NET patients reported at least one moderate-to-high need for disease specific information (63%). Medium- to large-sized differences in quality of life subscales were also observed with the functioning group reporting more anxiety compared to population norms., Conclusions: There is a need to improve the current provision of information for people with NETs., Practice Implications: These findings will inform the design and development of an informational resource to facilitate improved understanding for patients with NETs., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: This cross-sectional study examines patient-reported outcomes and functioning-based subgroups in human papillomavirus-associated oropharyngeal cancer survivors treated with chemoradiotherapy ≥12 months prior., Method: Survivors completed EORTC QLQ-C30, MDASI-HN and PROMIS-Emotional distress questionnaires. Subgroups were identified via two-step clustering of QLQ-C30 functioning scales., Results: 136 patients were enrolled. Clinicians' graded 19/136 (14%) patients as having at least one severe (Grade 3 CTCAE) toxicity, whereas 68/136 (50%) patients self-reported at least one toxicity in the severe range (MDASI-HN ≥ 7). QLQ-C30 Global health status score (mean 76, SD = 20) was comparable to population norms. Rates of moderate/severe anxiety (10%/1%) and depression (4%/1%) were low. Two functioning-based subgroups were formed based on auto-clustering statistics: high- (n = 93) and low-functioning (n = 41). Differences on all functioning scales were large (d: 1.57-2.29), as were differences on the remaining QLQ-C30 scales/items, most MDASI-HN symptom severity/interference scales, and PROMIS scales (d: 0.80-2.03). Differences and associations with patient/clinical characteristics were not significant., Conclusion: In this Australian cohort of HPV-OPC survivors there was significant discordance between clinician- and patient-reported toxicity. We observed population comparable global quality of life and low rates of emotional distress. However, we identified a low-functioning subgroup reporting significantly worse outcomes on a range of patient-reported measures who may benefit from targeted support., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The emergence of human papillomavirus-associated oropharyngeal cancer (HPVOPC) has resulted in an explosion of clinical research offering reduced toxicity and improved health-related quality of life (HRQL) through treatment de-escalation. At the heart of this objective are patient-reported outcomes (PROs) which aim to quantify the patient experience, usually through the measurement of HRQL or symptom burden. A number of PRO measures (PROMs) are available to HNC researchers and selection of the optimal instrument relies on a detailed understanding of their content and psychometric properties matched to the clinical endpoint of interest. As PROMs become increasingly favoured as the primary or co-primary endpoints of interest in HNC clinical trials, particularly those focussed on HPVOPC, future treatment paradigms will be determined by these measures and it is imperative that they are applied with sophistication and rigor. This review draws attention to the limitations and challenges our specialty faces in PRO application, analysis and reporting. These shortfalls typically include a reliance on statistical rather than clinically relevant differences, multiple hypothesis testing, a lack of evidence-based minimal clinically important differences for the commonly used tools, as well as variations in PROM selection. The aim of this review is to provide: (1) an overview of PRO/PROM terminology and methodology in the HNC setting; (2) to provide a summary of HRQL and symptom burden reports in the HPVOPC literature; and (3) to draw attention to the unmet research need of refining PROM development, application and interpretation to guide our treatment decisions based on what matters to patients., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: The present study examined the feasibility and effects of integrating a multidisciplinary team (MDT) model of care for women with metastatic breast cancer (MBC) into a large Australian cancer center. The challenges encountered and lessons learned are described., Patients and Methods: In the present prospective, longitudinal, mixed-methods implementation study, the MDT model included face-to-face consultations with a breast care nurse and social worker, followed by a MDT case discussion and face-to-face delivery of a personalized management plan. Data were collected to describe the cohort of women living with MBC who had attended a specialist breast cancer service and their supportive care needs., Results: A total of 62 women with median age of 60 years (interquartile range [IQR], 37-82 years) participated. The median interval from the first breast cancer diagnosis was 5.7 years (IQR, 2.0-11.6 years), and the median interval from the diagnosis of MBC was 2.0 years (IQR, 0.9-3.6 years). The MDT care model required new resources and cross-sector participation. However, the participants indicated a preference for personalized needs assessment and care planning at the diagnosis of MBC., Conclusions: The results highlight the challenges of implementing and evaluating an MDT care model for women with MBC. The model coordinated MDT collaboration to strengthen the delivery of complex care plans. Investment in cross-sector partnerships to optimize care coordination for women with MBC was needed., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Introduction: Non-small-cell lung cancer (NSCLC) has disproportionately negative outcomes in men compared with women. The importance of the relationship between sex and tumor, node, metastases (TNM) staging system remains unknown. The objective of this study was to investigate the effect of sex on NSCLC survival for each stage in the eighth edition of the TNM staging system in NSCLC., Patients and Methods: Two cohorts treated surgically with curative intent between 2000 and 2010 were analyzed. The primary cohort was from Australia with a second population set from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate analyses of putative and validated prognostic factors were undertaken to investigate sex-dependent prognostication with detailed analyses of sex differences in each TNM stage. The primary outcome was disease-specific survival (DSS) at 5 years., Results: Inclusion criteria were met by 555 patients in the Australian cohort, 335 men (60.4%) and 220 (39.6%) women; and 47,706 patients from the SEER cohort, 24,671 men (51.7%) and 23,035 women (48.3%). Five-year DSS was significantly worse for men in multivariate analyses for the Australian (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.04-1.98; P = .026) and SEER (HR, 1.24; 95% CI, 1.20-1.28; P < .001) cohorts. Detailed analysis of TNM stage sex differences revealed a consistent pattern of men having worse survival than women across stages in both cohorts., Conclusion: The poorer survival in men with NSCLC presents research and clinical communities with an important challenge. This study's findings suggest that for men and women diagnosed with NSCLC, and managed surgically, stage-specific outcomes should be quoted separately and consideration to a rapid prognostic score with sex combined with staging as a key element., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: A systematic review and qualitative synthesis was undertaken to deduce requisite knowledge, skills and attributes of cancer support group leaders., Methods: Medline, CINAHL, and PsychINFO databases were used to identify relevant literature. Inclusion criteria were made deliberately broad after pilot searches produced too few documents and included: adult group leaders who were volunteers, peers or professionals; published in English from database inception to February 2014. Data was extracted on: year of publication; country of authors' origin; study design (if relevant) and methods; group type and group leadership; sample description; and leader qualities., Results: Forty-nine documents met inclusion criteria. Fourteen reported on cancer groups, 31 on non-cancer groups (including four mixed groups) and four did not specify group type. Seven qualities were deduced including group management, group process, role modelling, awareness, willingness, agreeableness, and openness. These were consistent across group type and group leadership., Conclusions: Findings may be relevant to a general model of peer group support and can inform the development of a practical and realistic minimum standard for support group leadership in healthcare., Practice Implications: Results can be used to help cancer agencies manage relationships with group leaders. Knowledge of requisite qualities may inform selection, training and support., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background & Aims: Thoracic radiotherapy is associated with toxicities that can adversely impact nutritional intake. This study aimed to investigate the prevalence and predictors of ≥5% weight loss and commencement of enteral nutrition in lung cancer patients receiving radiotherapy., Methods: A retrospective study of 96 patients treated with high dose palliative or radical radiotherapy for a primary diagnosis of small cell or non-small cell lung cancer. Weight loss was calculated between the start and up to 90 days from radiotherapy commencement. Associations between ≥5% weight loss and enteral feeding, and demographic and clinical factors (age, gender, nutritional status, total dose of radiotherapy, concurrent chemotherapy, disease stage, prior surgery, hyper-fractionation and performance status) were assessed., Results: The prevalence of weight loss ≥5% was 31% (median weight loss 8%, range 5-19%). The prevalence of commencement of enteral nutrition was 12%. Patients receiving concurrent chemotherapy were more likely to have ≥5% weight loss (40 versus 0%, phi = 0.35, p < 0.001). The odds of a patient with late stage disease having ≥5% weight loss were 15 times greater than for a patient with earlier disease stage (95% CI 1.97, 122.8, p = 0.009). Only Patient Generated Subjective Global Assessment score was associated with starting enteral nutrition (r = 0.27, p = 0.03)., Conclusion: Clinically significant weight loss is prevalent in lung cancer patients receiving radiotherapy and is associated with concurrent chemotherapy and late stage disease. Identification of factors associated with weight loss assists with early identification and intervention in patients at high nutritional risk., (Copyright © 2013 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

The Hospital Anxiety and Depression Scale (HADS) has been used extensively as a screening tool for anxiety and depression in clinical and nonclinical groups. A number of published studies have provided support for the original bidimensional structure of the HADS; however, others have reported irregularities in the factor structure. This study investigated the psychometric properties of the HADS in 106 family caregivers caring for a patient dying of cancer. Caregivers had been recruited to a randomized controlled trial conducted to gain a longitudinal understanding of caregivers' appraisal of their role. Exploratory factor analysis and internal consistency reliability statistics were used to investigate the underlying structure of the HADS. Descriptive statistics were calculated for author-defined subscale scores to assess levels of anxiety and depression among family caregivers. Two- and three-factor models were explored; however, the two-factor model, which closely resembled the intended bidimensional structure, was preferred. Mean author-defined subscale scores indicated higher levels of anxiety and depression in family caregivers than those previously reported for various general population, general practice, and cancer patient samples. Routine screening of anxiety and depression in family caregivers appears warranted based on the results of this study. The HADS may be a suitable screening tool, as indicated by its bidimensional structure; however, further research is required to establish its diagnostic efficiency in this population.