Content analysis of rehabilitation goals for patients following non-surgical head and neck cancer treatment
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Following head and neck cancer (HNC) treatment, individuals experience an array of side effects which can impact on physical, emotional, and practical aspects of their lives. Responsive, supportive rehabilitation services are therefore essential to address ongoing survivorship needs. This study examined the nature of patient-reported goals from acute to long-term post-treatment, to inform design/delivery of future rehabilitation services.
Using a cross-sectional cohort design, 91 patients between 2 weeks and 5 years of post non-surgical HNC treatment (acute n = 29; sub-acute n = 28; long-term n = 34), provided their top four rehabilitation goals considering any aspect of their lives. Content analysis was used to categorise responses at each time point.
Three core categories of patient goals were identified relating to: (1) treatment side effects (TSE), (2) overall health (OH), and (3) living life (LL). TSE goals were a priority during the acute and sub-acute phases, with less focus long-term. LL goals were prevalent across all time points, though increased in the long-term. Approximately a third of all goals at each time point related to OH.
A variety of rehabilitation goals were identified, and the focus shifted over time. These data highlight the importance of changing the focus of rehabilitation as patients’ priorities vary over time. Early multidisciplinary care from allied health services is crucial to provide support with managing side effects and returning to daily activities. In the long-term, greater input from services to address health, nutrition, leisure, and fitness goals may be more beneficial.
KeywordsHead and neck cancer Rehabilitation Goals Survivorship (chemo)Radiotherapy
The authors wish to thank the speech pathology department, research team, and multidisciplinary team at Prince of Wales Hospital and Princess Alexandra Hospital for their contributions and continued support to this project.
This project was funded by the Head and Neck Cancer Research Fund at Prince of Wales Hospital, Sydney, Australia.
Compliance with ethical standards
Conflict of interest
The author has been funded by the institution (Prince of Wales Hospital, Australia) where the research was conducted. The author has full control of all primary data and agrees to allow the journal to review the data if requested.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
- 2.Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI, Nguyen-Tân PF, Westra WH, Chung CH, Jordan RC, Lu C, Kim H, Axelrod R, Silverman CC, Redmond KP, Gillison ML (2010) Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 363(1):24–35. https://doi.org/10.1056/NEJMoa0912217 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Ghazali N, Roe B, Lowe D, Rogers SN (2015) Patients concerns inventory highlights perceived needs and concerns in head and neck cancer survivors and its impact on health-related quality of life. Br J Oral Maxillofac Surg 53(4):371–379. https://doi.org/10.1016/j.bjoms.2015.01.022 CrossRefPubMedGoogle Scholar
- 6.Cohen EEW, LaMonte SJ, Erb NL, Beckman KL, Sadeghi N, Hutcheson KA, Stubblefield MD, Abbott DM, Fisher PS, Stein KD, Lyman GH, Pratt-Chapman ML (2016) American Cancer Society head and neck cancer survivorship care guideline. CA Cancer J Clin 66(3):203–239. https://doi.org/10.3322/caac.21343 CrossRefPubMedGoogle Scholar
- 7.Barnhart MK, Robinson RA, Simms VA, Ward EC, Cartmill B, Chandler SJ, Smee RI (2018) Treatment toxicities and their impact on oral intake following non-surgical management for head and neck cancer: a 3-year longitudinal study. Support Care Cancer 26:2341–2351. https://doi.org/10.1007/s00520-018-4076-6 CrossRefPubMedGoogle Scholar
- 10.Bressan V, Bagnasco A, Aleo G, Catania G, Zanini MP, Timmins F, Sasso L (2017) The life experience of nutrition impact symptoms during treatment for head and neck cancer patients: a systematic review and meta-synthesis. Support Care Cancer 25(5):1699–1712. https://doi.org/10.1007/s00520-017-3618-7 CrossRefPubMedGoogle Scholar
- 11.Murphy BA, Beaumont JL, Isitt J, Garden AS, Gwede CK, Trotti AM, Meredith RF, Epstein JB, Le QT, Brizel DM, Bellm LA, Wells N, Cella D (2009) Mucositis-related morbidity and resource utilization in head and neck cancer patients receiving radiation therapy with or without chemotherapy. J Pain Symptom Manag 38(4):522–532. https://doi.org/10.1016/j.jpainsymman.2008.12.004 CrossRefGoogle Scholar
- 12.Pauloski, Rademaker AW, Logemann JA, Lundy D, Bernstein M, McBreen C, Santa D, Campanelli A, Kelchner L, Klaben B, Discekici-Harris M (2011) Relation of mucous membrane alterations to oral intake during the first year after treatment for head and neck cancer. Head Neck 33(6):774–779. https://doi.org/10.1002/hed.21542 CrossRefPubMedGoogle Scholar
- 13.McLaughlin LRNP (2013) Taste dysfunction in head and neck cancer survivors. Oncol Nurs Forum 40(1):E4–E13Google Scholar
- 14.Kraaijenga SC, van der Molen L, Jacobi I, Hamming-Vrieze O, Hilgers FM, van den Brekel MM (2015) Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises. Eur Arch Otorhinolaryngol 272(11):3521–3531. https://doi.org/10.1007/s00405-014-3379-6 CrossRefPubMedGoogle Scholar
- 15.Vainshtein JM, Samuels S, Tao Y, Lyden T, Haxer M, Spector M, Schipper M, Eisbruch A (2016) Impact of xerostomia on dysphagia after chemotherapy–intensity-modulated radiotherapy for oropharyngeal cancer: prospective longitudinal study. Head Neck 38(S1):E1605–E1612. https://doi.org/10.1002/hed.24286 CrossRefPubMedGoogle Scholar
- 16.Bressan V, Stevanin S, Bianchi M, Aleo G, Bagnasco A, Sasso L (2016) The effects of swallowing disorders, dysgeusia, oral mucositis and xerostomia on nutritional status, oral intake and weight loss in head and neck cancer patients: a systematic review. Cancer Treat Rev 45:105–119. https://doi.org/10.1016/j.ctrv.2016.03.006 CrossRefPubMedGoogle Scholar
- 17.Molassiotis A, Rogers M (2012) Symptom experience and regaining normality in the first year following a diagnosis of head and neck cancer: a qualitative longitudinal study. Palliat Support Care 10(3):197–204. https://doi.org/10.1017/S147895151200020X 10.1016/j.critrevonc.2006.07.005CrossRefPubMedGoogle Scholar
- 18.Larsson M, Hedelin B, Athlin E (2007) Needing a hand to hold: lived experiences during the trajectory of care for patients with head and neck cancer treated with radiotherapy. Cancer Nurs 30(4):324–334. https://doi.org/10.1097/01.ncc.0000281722.56996.07 CrossRefPubMedGoogle Scholar
- 20.Jefford M, Karahalios E, Pollard A, Baravelli C, Carey M, Franklin J, Aranda S, Schofield P (2008) Survivorship issues following treatment completion—results from focus groups with Australian cancer survivors and health professionals. J Cancer Surviv 2(1):20–32. https://doi.org/10.1007/s11764-008-0043-4 CrossRefPubMedGoogle Scholar
- 21.Passchier E, Stuiver MM, van der Molen L, Kerkhof SI, van den Brekel MW, Hilgers FJ (2016) Feasibility and impact of a dedicated multidisciplinary rehabilitation program on health-related quality of life in advanced head and neck cancer patients. Eur Arch Otorhinolaryngol 273(6):1577–1587. https://doi.org/10.1007/s00405-015-3648-z CrossRefPubMedGoogle Scholar
- 23.McEwen S, Rodriguez AM, Martino R, Poon I, Dunphy C, Rios JN, Ringash J (2016) “I didn’t actually know there was such a thing as rehab”: survivor, family, and clinician perceptions of rehabilitation following treatment for head and neck cancer. Support Care Cancer 24(4):1449–1453. https://doi.org/10.1007/s00520-015-3021-1 CrossRefPubMedGoogle Scholar
- 24.Cancer Australia and Cancer Voices Australia (2011) National framework for consumer involvement in cancer control. Cancer Australia. ACT, CanberraGoogle Scholar
- 25.Tschiesner U, Sabariego C, Linseisen E, Becker S, Stier-Jarmer M, Cieza A, Harreus U (2013) Priorities of head and neck cancer patients: a patient survey based on the brief ICF core set for HNC. Eur Arch Otorhinolaryngol 270(12):3133–3142. https://doi.org/10.1007/s00405-013-2446-8 CrossRefPubMedGoogle Scholar
- 26.Kanatas A, Ghazali N, Lowe D, Udberg M, Heseltine J, O’Mahony E, Rogers SN (2013) Issues patients would like to discuss at their review consultation: variation by early and late stage oral, oropharyngeal and laryngeal subsites. Eur Arch Otorhinolaryngol 270(3):1067–1074. https://doi.org/10.1007/s00405-012-2092-6 CrossRefPubMedGoogle Scholar
- 28.Rogers SN, El-Sheikha J, Lowe D (2009) The development of a Patients Concerns Inventory (PCI) to help reveal patients concerns in the head and neck clinic. Oral Oncol 45(7):555–561. https://doi.org/10.1016/j.oraloncology.2008.09.004 CrossRefPubMedGoogle Scholar
- 30.Rogers SN, Laher SH, Overend L, Lowe D (2002) Importance-rating using the University of Washington Quality of Life questionnaire in patients treated by primary surgery for oral and oro-pharyngeal cancer. J Cranio-Maxillofac Surg 30(2):125–132. https://doi.org/10.1054/jcms.2001.0273 CrossRefGoogle Scholar
- 31.Clinical Oncology Society of Australia Model of Survivorship Care Working Group (2016) Model of survivorship care: critical components of cancer survivorship care in Australia position statement. Clinical Oncology Society of AustraliaGoogle Scholar
- 33.Cartmill B, Cornwell P, Ward E, Davidson W, Porceddu S (2012) Long-term functional outcomes and patient perspective following altered fractionation radiotherapy with concomitant boost for oropharyngeal cancer. Dysphagia 27(4):481–490. https://doi.org/10.1007/s00455-012-9394-0 CrossRefPubMedGoogle Scholar
- 34.Cooperstein E, Gilbert J, Epstein JB, Dietrich MS, Bond SM, Ridner SH, Wells N, Cmelak A, Murphy BA (2012) Vanderbilt head and neck symptom survey version 2.0: report of the development and initial testing of a subscale for assessment of oral health. Head Neck 34(6):797–804. https://doi.org/10.1002/hed.21816 CrossRefPubMedGoogle Scholar
- 36.Hutcheson KA, Lewin JS, Holsinger FC, Steinhaus G, Lisec A, Barringer DA, Lin HY, Villalobos S, Garden AS, Papadimitrakopoulou V, Kies MS (2014) Long-term functional and survival outcomes after induction chemotherapy and risk-based definitive therapy for locally advanced squamous cell carcinoma of the head and neck. Head Neck 36(4):474–480. https://doi.org/10.1002/hed.23330 CrossRefPubMedGoogle Scholar
- 41.McEwen S, Dunphy C, Rios JN, Davis A, Jones J, Lam A, Poon I, Martino R, Ringash J (2017) Development and pre-testing of a rehabilitation planning consultation for head-and-neck cancer. 24(3):8. https://doi.org/10.3747/co.24.3529