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      Análise da qualidade de vida dos pacientes com câncer de laringe em hospital de referência na região Sudeste do Brasil Translated title: Quality of life analysis in laryngeal cancer patients at a referral hospital in Southeastern Brazil

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          Abstract

          OBJETIVO: estimar a qualidade de vida e fatores a ela associados de uma amostra de pacientes portadores de tumor laríngeo, na região Sudeste do Brasil. MÉTODO: amostra constituída por 60 pacientes em tratamento para o câncer de laringe em 2 Hospitais do município de Juiz de Fora, estado de Minas Gerais (Brasil), cidade polo regional e referência para tratamento de cânceres de cabeça e pescoço na região sudeste do Brasil. Com a aplicação do questionário Functional Assessment Cancer Therapy- Head & Neck , foram coletados os dados e submetidos à análises bivariada e multivariada, para atestar a implicação das variáveis na qualidade de vida dos pacientes de instituições de atenção terciária para tratamento de câncer. RESULTADOS: na análise bivariada, foram significantes as variáveis: sexo; anos de escolaridade; análise do tratamento recebido; acompanhamento fonoaudiológico e nutricional. Após a análise multivariada, ainda demonstraram associação independente: análise do tratamento recebido, tratamento fonoaudiológico e nutricional. CONCLUSÕES: a qualidade de vida dos pacientes envolvidos no estudo pode ser avaliada como satisfatória, sendo influenciada pelo bem-estar físico e funcional. O questionário Functional Assessment Cancer Therapy- Head & Neck, específico para cabeça e pescoço, mostrou que além dos fatores socioeconômicos e clínico-funcionais, os sociodemográficos também estão ligados à qualidade de vida dos portadores de câncer de laringe. Foi demonstrada também a importância do tratamento reabilitador fonoaudiológico e nutricional no ganho da qualidade de vida dos pacientes.

          Translated abstract

          PURPOSE: to estimate the quality of life and associated factors in a sample of patients with laryngeal tumor, in Southeastern Brazil. METHOD: sample of 60 patients treated for laryngeal cancer in two hospitals in the city of Juiz de Fora, Minas Gerais (Brazil), city and regional center of excellence for the treatment of head and neck cancers in southeastern Brazil. With the application of the questionnaire Functional Assessment Cancer Therapy-Head & Neck, data were collected and submitted to bivariate and multivariate analysis to demonstrate the involvement of variables in the quality of life of institutions of tertiary care for treatment of cancer. RESULTS: in bivariate analysis (p ≤ 0.20) were significant variables: gender, years of education, analysis of treatment received, speech therapy and nutrition. After multivariate analysis also demonstrated an independent association: analysis of treatment received, speech therapy and nutrition. CONCLUSIONS: the quality of life of patients in the study can be evaluated as satisfactory, being influenced by the physical well-being and functional. The questionnaire Functional Assessment Cancer Therapy-Head & Neck, specific for head and neck, showed that economic factors, clinical and functional, demographic are also linked to quality of life of patients with laryngeal cancer. Also demonstrated was the importance of speech therapy and nutritional rehabilitation treatment gain in quality of life of patients.

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          The Performance Status Scale for Head and Neck Cancer Patients and the Functional Assessment of Cancer Therapy-Head and Neck Scale. A study of utility and validity.

          The goal of this investigation was to examine the relationship between, and application of, two disease specific quality of life (QL) measures currently being employed for head and neck cancer patients: the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACT-H&N) and the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN). The FACT-H&N and PSS-HN were administered to 151 head and neck cancer patients with a range of disease sites, treatment status (on vs. off treatment), and treatment modalities (surgery, radiation, and chemotherapy). FACT-H&N subscale and total scores and PSS-HN subscale scores proved sensitive to patients groups (showed significant and clinically meaningful differences) on the basis of treatment status (on vs. off treatment) and global performance status (Karnofsky scores). The pattern of correlations between FACT-H&N and PSS-HN subscales supported the scales' construct (convergent vs. divergent) validity. The strongest and most significant associations were observed between PSS-HN Normalcy of Diet and Eating in Public, and the head and neck subscale (HNS) of FACT-H&N, both of which were designed to measure the unique problems of head and neck cancer patients. More modest associations were observed between subscales measuring physical and functional areas of performance, social functioning, and emotional well-being. The FACT-HNS was found to be reliable and valid when applied to head and neck cancer patients. It clearly adds information to that collected by the parent (core) instrument. The PSS-HN also provides unique information, independent of that provided by the Karnofsky or the FACT-H&N. This study supported the multidimensional nature of QL for head and neck cancer patients, and thus the importance of assessing disease specific concerns in addition to general health status when assessing functional and QL outcome.
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            Effects of chemoradiotherapy on voice and swallowing.

            Chemotherapy has been found to result in comparable survival rates to surgery for head and neck cancer. However, toxicity can often be worse after chemoradiotherapy, with impairment in voice, swallowing, nutrition, and quality of life. Investigators are attempting to modify radiotherapy treatment regimens to spare organs that have an impact on swallowing. This review will highlight voice and swallowing impairment seen after chemoradiotherapy, as well as treatment for voice and swallowing disorders in this population. Results of newer radiotherapy regimens will also be highlighted. Specific oropharyngeal swallowing motility disorders after chemoradiotherapy have been identified. Damage to specific structures has been correlated with specific pharyngeal phase swallow impairment. Swallowing function and quality of life have been examined over time, with improvement seen in both. Preventive/prophylactic swallow exercise programs have been encouraging. Chemoradiotherapy effects on voice have been identified in terms of acoustic, aerodynamic, and patient and clinician-rated perception of function. Improvement in voice has also been observed over time after chemoradiotherapy. Voice therapy has been found to have a positive impact on voice and perceptual measures in this population. Current studies show some improvement in swallow function after swallow and voice therapy in patients treated with chemoradiotherapy. Further, there is a suggestion of improved swallow function with sparing of organs with specific radiotherapy protocols. Future research needs to focus on specific voice and swallow treatment regimens in the head and neck cancer patient treated with chemoradiotherapy, specifically, timing, frequency, duration, and specific treatment types.
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              The effect of age on survival and quality of life in elderly head and neck cancer patients: a long-term prospective study.

              Little is known about long-term treatment outcome of elderly head and neck cancer patients and their quality of life (QOL). One hundred and eighteen older (>or=70 years) and 148 younger (45-60 years) patients with head and neck cancer were followed up for 3-6 years. In the long-term follow-up 33 younger and 24 older patients completed the EORTC QLQ-C30 and H&N35 and a questionnaire about depression. The survival rate after 3-6 years for younger patients was 36%, as compared to 31% in the older patient group. Higher tumour stages, more co-morbidity and non-standard treatment showed to be independent prognostic factors for mortality. No independent prognostic value of age could be found. The global QOL score remains roughly comparable. Even up to 6 years after treatment, we found no significant differences in survival or overall QOL between older and younger head and neck cancer patients.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                rcefac
                Revista CEFAC
                Rev. CEFAC
                CEFAC Saúde e Educação (São Paulo )
                1982-0216
                August 2013
                : 15
                : 4
                : 932-940
                Affiliations
                [1 ] Hospital Monte Sinai Brazil
                [2 ] Universidade Federal de Juiz de Fora Brazil
                [3 ] Universidade Federal de Juiz de Fora Brazil
                [4 ] Instituto Oncológico Brazil
                Article
                S1516-18462013000400022
                10.1590/S1516-18462013000400022
                a14192a5-a4ae-43e0-8f74-7af1df8d2682

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1516-1846&lng=en
                Categories
                REHABILITATION

                Physiotherapy
                Epidemiology,Laryngeal Neoplasms,Quality of Life,Epidemiologia,Neoplasias Laríngeas,Qualidade de Vida

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