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Objective: To identify patient groups that are prone to poorer quality of life (QoL) during the first 3 months following discharge from the hospital after surgery for head and neck cancer. Design: Prospective evaluation of the QoL of surgically treated head and neck cancer patients measured with questionnaires at discharge and at 6 weeks and 3 months after discharge. Setting: Department of Otolaryngology and Head and Neck Surgery of the Erasmus University Medical Centre, a tertiary health care centre in Rotterdam, the Netherlands. Participants: Ninety head and neck cancer patients who had undergone a total laryngectomy, neck dissection, or the commando procedure. Main Outcome Measures: Patients' quality of life in 22 different dimensions. Results: Three patient characteristics associated with poorer QoL during the first 3 months following discharge from the hospital after surgery for head and neck cancer: laryngectomy, lower levels of education, and being single. QoL already improved in eight QoL dimensions during the first 3 months after discharge, but QoL in the dimensions "loss of control" and "physical self-efficacy" worsened during this same period. Conclusions: It is possible to identify patient groups that are prone to poorer QoL during the first 3 months following discharge from the hospital after surgery for head and neck cancer. The results of this study may help care providers working with head and neck cancer patients to tailor their rehabilitation programs. [ABSTRACT FROM AUTHOR]

Objectives: In shared decision making it is important to adequately, timely and actively involve patients in treatment decisions. Sharing prognostic information can be of key importance. This study describes whether and how prognostic information on life expectancy is included during communication on diagnosis and treatment plans between physicians and head and neck (H&N) oncologic patients in different phases of disease.Methods: A descriptive, qualitative study was performed of n = 23 audiotaped physician-patient conversations in which both palliative and curative treatment options were discussed and questions on prognosis were expected. Verbatim transcribed consultations were systematically analyzed. A distinction was made between prognostic information that was provided (a) quantitatively: by giving numerical probability estimates, such as percentages or years or (b) qualitatively: through the use of words such as 'most likely' or 'highly improbable'.Results: In all consultations, H&N surgeons provided some prognostic information. In 5.9% of the provided prognostic information, a quantitative method was used. In 94.1% prognostic information was provided qualitatively, using six identified approaches. H&N surgeons possibly affect patients' perception of prognostic content with two identified communication styles: directive (more physician-centered) and affective (more patient-centered).Conclusion: This study is first in providing examples of how H&N surgeons communicate with their patients regarding prognosis in all stages of disease. They often exclude specific prognostic information. The study outcomes can be used as a first step in developing a guideline for sharing prognostic information in H&N oncologic patients, in order enable the process of shared decision making. [ABSTRACT FROM AUTHOR]

Conclusion: The findings of this study justify the goals of the Expert Centre such as the improvement of somatic and psychosocial care and consultation. Objective: A recent review showed that little attention is paid to palliative care for head and neck patients. The Erasmus MC has initiated an Expert Centre of Palliative Care Head and Neck Oncology with special interest in patient care, consultation and research. In this study the experience of general practitioners (GPs) in their care of palliative head and neck cancer patients before the start of the Expert Centre is assessed. The aim of the study was to find possible gaps in care and communication and to use GP's ideas to improve the centre's functioning. Materials and methods: Fifty-five GPs with a patient in their practice who died from head and neck cancer between January 2003 and July 2004 after being treated in the Erasmus MC were included. The GPs were asked to fill out a questionnaire regarding their experience in the care of palliative head and neck cancer patients, the communication between first- and third-line care providers and the work of both the GP and the specialist involved. Results: The response rate was 75%. The palliative stage lasted approximately 4 months. The GPs felt that symptom control was generally not sufficient. Also improvements were necessary in psychosocial care and in the communication between first- and third-line care providers. They also experienced gaps in their knowledge of specific head and neck oncologic palliative care. [ABSTRACT FROM AUTHOR]

Summary: Objective:: To determine use, appreciation and effectiveness of an electronic health information support system in head and neck (H&N) cancer care. Design:: A prospective evaluation study. The evaluated system has four different functions: (1) communication amongst health care providers and between health care providers and patients, (2) information for health care providers and patients, (3) contact with fellow sufferers and (4) monitoring of discharged patients by means of electronic questionnaires. Evaluation of the system was done both objectively using automatically created log files and stored messages, and subjectively by using paper questionnaires from patients and general practitioners (GPs). Setting:: Department of Otorhinolaryngology and Head and Neck Surgery of a tertiary health care centre in the Netherlands. The system was put at patients’ disposal for a period of 6 weeks following discharge from the hospital after surgery for H&N cancer, and was additional to standard care. Participants:: Head and neck cancer patients, hospital physicians, members of a hospital-based support team, GPs, district nurses and speech therapists. Main outcome measures:: Actual use of the system by patients and health care providers. Patients’ appreciation for each of the system''s four different functions. GPs’ appreciation for the system. Capability to detect potential patient problems with the system. Results:: The system was used by 36 H&N cancer patients, 10 hospital physicians, 2 members of the support team, 8 GPs, 2 district nurses and 2 speech therapists. The total number of patient-sessions was 982: an average of 27.3 sessions per patient during the 6 weeks study period. In total, 456 monitoring questionnaires were completed. The support team in hospital responded with 231 actions. In 16 cases, an extra appointment was made for a patient with the hospital physician. Out of these cases, immediate action was considered necessary eight times. Patients appreciated the system highly, rating it with an average score of 8.0 on a 10-point scale. All patients used the monitoring function, and rated ‘monitoring’ with a mean score of 8.0 on a 10-point scale. Least used and appreciated was the ‘contact with fellow sufferers’ function. Only 8 out of possible 36 GPs used the system, rating it with an average of 5.6 on a 10-point scale. Conclusions:: The electronic health information support system was used intensively and highly appreciated by H&N cancer patients. The system enabled the early detection of occurring health problems that required direct intervention. ICT can play an additional role in the management of patients, also in a relatively elderly and computer illiterate patient population. [Copyright &y& Elsevier]

Abstract: Background and purpose: An evidence-based clinical practice guideline for laryngeal carcinomas was introduced in the Netherlands late 1999. The objective of this guideline was to ensure uniformity in the diagnosis, treatment, and follow-up. We retrospectively evaluated whether clinical practice changed according to the recommendations of this guideline and whether it succeeded in its aim. Material and methods: In five out of eight Dutch university hospitals, chart data of 459 patients treated before the guideline introduction were compared to data of 363 patients treated after the guideline introduction. Results: Patient and tumour characteristics were comparable among both groups. In general, the guideline recommendations were properly complied with. The patients treated before the guideline introduction were actually also for a large part already treated according to the guideline''s recommendations. After its introduction, several changes according to the guideline were observed: increased rates of reassessment of biopsy samples taken in local hospitals, psychological screening (although still only performed in 10.5% of patients), application of accelerated radiotherapy schedules, clinical trial treatments, function-preserving treatments, and decreased rates of total laryngectomy, and annual chest X-rays during follow-up. Conclusions: Although a causal relationship cannot be established in this kind of observational studies, several positive changes were observed after the introduction of the guideline, and therefore the guideline seems to have contributed to more uniformity. The largest changes were seen for the guideline recommendations based on the highest levels of evidence. [Copyright &y& Elsevier]

Objective: To investigate how general practitioners (GPs) value an additional letter from the hospital. This so-called preadmission letter informs the GP about planned surgery for head and neck cancer in one of their patients. Design: Prospective survey among GPs by means of a questionnaire attached to the preadmission letter. Setting: Department of Otolaryngology and Head and Neck Surgery of a tertiary care centre in the Netherlands and 104 different GPs in primary care. Participants: All GPs of patients undergoing surgery for head and neck cancer received the preadmission letter during a 1-year study period. Main Outcome Measures: GPs' appreciation of the received preadmission letter, GPs' opinion on the content of the preadmission letter, and GPs' general opinion on information provided by our hospital. Results: Of the 145 preadmission letters sent during the study year, 115 questionnaires were returned (response rate of 79%). All GPs positively appreciated receiving the preadmission letter and considered its content relevant. They valued the letter, with a mean mark of 8.3 on a 10-point scale. The majority of the GPs agreed that the preadmission letter allows them to provide better care. Conclusions: GPs highly appreciate an extra letter informing them about intended surgery for head and neck cancer in one of their patients. Despite the basic content of the preadmission letter (five items only), the majority of GPs consider the information sufficient. The results of this study have led to the implementation of the preadmission letter to GPs of head and neck cancer patients on a permanent basis in our institution. [ABSTRACT FROM AUTHOR]

Purpose: Comparison of quality of life (QoL) and side effects in a randomized trial for early hyperbaric oxygen therapy (HBOT) after radiotherapy (RT). Methods and Materials: From 2006, 19 patients with tumor originating from the tonsillar fossa and/or soft palate (15), base of tongue (1), and nasopharynx (3) were randomized to receive HBOT or not. HBOT consisted of 30 sessions at 2.5 ATA (15 msw) with oxygen breathing for 90 min daily, 5 days per week, applied shortly after the RT treatment was completed. As of 2005, all patients received validated questionnaires (i.e., the European Organization for Research and Treatment of Cancer [EORTC] QLQ-C30, EORTC QLQ Head and Neck Cancer Module (H&N35), Performance Status Scale): before treatment; at the start of RT treatment; after 46 Gy; at the end of RT treatment; and 2, 4, and 6 weeks and 3, 6, 12, and 18 months after follow-up. Results: On all QoL items, better scores were obtained in patients treated with hyperbaric oxygen. The difference between HBOT vs. non-HBOT was significant for all parameters: EORTC H&N35 Swallowing (p = 0.011), EORTC H&N35 Dry Mouth (p = 0.009), EORTC H&N35, Sticky Saliva (p = 0.01), PSS Eating in Public (p = 0.027), and Pain in Mouth (visual analogue scale; p < 0.0001). Conclusions: Patients randomized for receiving hyperbaric oxygen after the RT had better QoL scores for swallowing, sticky saliva, xerostomia, and pain in mouth. [Copyright &y& Elsevier]

Many cancer patients experience psychosocial problems that go unnoticed by caregivers. To improve this situation, an instrument has been developed and tested to identify such problems. This instrument, the integral checklist, was put to the test in two outpatient departments of different hospitals with an intervention and a control group (105 and 124 patients, respectively). To evaluate the efficiency of the checklist, both groups had to complete a questionnaire after consultation. Results showed that the checklist assisted specialists to be more often pro-active in discussing psychosocial problems with their patients, and more patients with psychosocial problems were referred. Most of the patients appreciated going through the checklist with their specialist. The checklist proves to fit in well with hospital routines and using it costs the specialist no extra time. It appears to be an instrument which improves efficiency of consultation. Moreover, the checklist is turned out to be useful as a management tool to divert patients’ attention away from the waiting time. [Copyright &y& Elsevier]