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      Prevalence and clinical and psychological correlates of high fear of cancer recurrence in patients newly diagnosed with head and neck cancer

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          Patients with head and neck cancer (HNC) are vulnerable to fear of cancer recurrence (FCR) and psychiatric morbidity. We investigated the prevalence of high FCR and demographic, clinical, psychological, and psychiatric factors associated with high FCR prior to the start of the treatment.


          In a cross‐sectional substudy of the large ongoing prospective NET‐QUBIC study questionnaires and psychiatric interviews of 216 patients newly diagnosed with HNC were analyzed.


          High FCR was observed in 52.8% of patients and among those 21.1% also had a lifetime history of selected anxiety or major depressive disorder. FCR was not related to any clinical characteristics; however, younger age, higher anxiety symptoms, introversion, greater needs for support regarding sexuality, and being an exsmoker were significantly associated with higher FCR.


          Factors associated with high FCR provide us with a better conceptual understanding of FCR in patients newly diagnosed with HNC.

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          Most cited references 62

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          The hospital anxiety and depression scale.

           R Snaith,  S Zigmond (1983)
          A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.
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            The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.

            In 1986, the European Organization for Research and Treatment of Cancer (EORTC) initiated a research program to develop an integrated, modular approach for evaluating the quality of life of patients participating in international clinical trials. We report here the results of an international field study of the practicality, reliability, and validity of the EORTC QLQ-C30, the current core questionnaire. The QLQ-C30 incorporates nine multi-item scales: five functional scales (physical, role, cognitive, emotional, and social); three symptom scales (fatigue, pain, and nausea and vomiting); and a global health and quality-of-life scale. Several single-item symptom measures are also included. The questionnaire was administered before treatment and once during treatment to 305 patients with nonresectable lung cancer from centers in 13 countries. Clinical variables assessed included disease stage, weight loss, performance status, and treatment toxicity. The average time required to complete the questionnaire was approximately 11 minutes, and most patients required no assistance. The data supported the hypothesized scale structure of the questionnaire with the exception of role functioning (work and household activities), which was also the only multi-item scale that failed to meet the minimal standards for reliability (Cronbach's alpha coefficient > or = .70) either before or during treatment. Validity was shown by three findings. First, while all interscale correlations were statistically significant, the correlation was moderate, indicating that the scales were assessing distinct components of the quality-of-life construct. Second, most of the functional and symptom measures discriminated clearly between patients differing in clinical status as defined by the Eastern Cooperative Oncology Group performance status scale, weight loss, and treatment toxicity. Third, there were statistically significant changes, in the expected direction, in physical and role functioning, global quality of life, fatigue, and nausea and vomiting, for patients whose performance status had improved or worsened during treatment. The reliability and validity of the questionnaire were highly consistent across the three language-cultural groups studied: patients from English-speaking countries, Northern Europe, and Southern Europe. These results support the EORTC QLQ-C30 as a reliable and valid measure of the quality of life of cancer patients in multicultural clinical research settings. Work is ongoing to examine the performance of the questionnaire among more heterogenous patient samples and in phase II and phase III clinical trials.
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              Pain assessment: global use of the Brief Pain Inventory.

              Poorly controlled cancer pain is a significant public health problem throughout the world. There are many barriers that lead to undertreatment of cancer pain. One important barrier is inadequate measurement and assessment of pain. To address this problem, the Pain Research Group of the WHO Collaborating Centre for Symptom Evaluation in Cancer Care has developed the Brief Pain Inventory (BPI), a pain assessment tool for use with cancer patients. The BPI measures both the intensity of pain (sensory dimension) and interference of pain in the patient's life (reactive dimension). It also queries the patient about pain relief, pain quality, and patient perception of the cause of pain. This paper describes the development of the Brief Pain Inventory and the various applications to which the BPI is suited. The BPI is a powerful tool and, having demonstrated both reliability and validity across cultures and languages, is being adopted in many countries for clinical pain assessment, epidemiological studies, and in studies of the effectiveness of pain treatment.

                Author and article information

                Head Neck
                Head Neck
                Head & Neck
                John Wiley & Sons, Inc. (Hoboken, USA )
                07 June 2019
                September 2019
                : 41
                : 9 ( doiID: 10.1002/hed.v41.9 )
                : 3187-3200
                [ 1 ] Department of Family Medicine Medical Faculty Ljubljana Ljubljana Slovenia
                [ 2 ] Department of Medical Psychology Radboud University Medical Centre Nijmegen The Netherlands
                [ 3 ] Department of Medical Oncology Radboud University Medical Centre Nijmegen The Netherlands
                [ 4 ] Department of Radiation Oncology Radboud University Medical Centre Nijmegen The Netherlands
                [ 5 ] Department Maxillofacial Surgery Radboud University Medical Centre Nijmegen The Netherlands
                [ 6 ] School of Medicine University of St. Andrews St. Andrews Scotland, UK
                [ 7 ] Department of Otolaryngology and Head and Neck Surgery Erasmus Cancer Institute, Erasmus MC Rotterdam The Netherlands
                [ 8 ] Department of Radiation Oncology University of Groningen, University Medical Centre Groningen Groningen The Netherlands
                [ 9 ] Department of Otolaryngology‐Head and Neck Surgery VU University Medical Center Amsterdam The Netherlands
                [ 10 ] Department of Radiotherapy University Medical Center Utrecht The Netherlands
                [ 11 ] Department of Clinical Psychology Vrije Universiteit Amsterdam The Netherlands
                [ 12 ] Department of Head and Neck Oncology Radboud University Medical Centre Nijmegen The Netherlands
                [ 13 ] Project Kubus, Vumc, Afdeling KNO Amsterdam The Netherlands
                Author notes
                [* ] Correspondence

                Spela Mirosevic, Department of Family Medicine, Medical Faculty Ljubljana, Poljanski nasip 58, 1000 Ljubljana, Slovenia.

                Email: spela.mirosevic@

                © 2019 The Authors. Head & Neck published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 1, Tables: 4, Pages: 14, Words: 10087
                Funded by: Dutch Cancer Society (KWF‐ Alpe d'Huzes)
                Funded by: Medical Faculty Ljubljana, Department of Family Medicine
                Funded by: Slovenian Research Agency (Young Researcher Program)
                Original Article
                Original Articles
                Custom metadata
                September 2019
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.9 mode:remove_FC converted:01.10.2019


                head and neck cancer, smoking, fear of recurrence, depression, anxiety


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