| 1. |
- Almståhl, Annica, 1973, et al.
(författare)
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Explorative study on mucosal and major salivary secretion rates, caries and plaque microflora in head and neck cancer patients
- 2018
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Ingår i: International Journal of Dental Hygiene. - : Wiley. - 1601-5029. ; 16:4, s. 450-458
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To analyse mucosal and major salivary secretion rates, caries and plaque microflora in connection with treatment for cancer in the head and neck region. Methods: Thirty-three patients were included and the number of teeth, filled surfaces and caries lesions registered. The labial and buccal gland secretion and stimulated whole salivary secretion rates were determined. Supragingival plaque microflora was analysed using cultivation technique. Data were collected pretreatment, during treatment and 6 months, 1 year and 2 years post-treatment. Results: Two years post-treatment, 36% had new caries lesions, which had been restored. The labial secretion was comparable with pretreatment, while the buccal secretion was lower (P < .001). The stimulated secretion rate was lower compared with pretreatment (P < .001) and was 0.7 mL/minute for 50%. Growth of lactobacilli increased during treatment (P < .001) and remained increased (P < .001), while growth of mutans streptococci was decreased (P < .01) 2 years post-treatment. Growth of Candida increased over time and was higher 2years post-treatment compared with pretreatment (P < .001) while growth of Prevotella was lower (P < .01). Conclusions: Two years post-treatment, the stimulated salivary secretion rate was substantially decreased, acid-tolerant lactobacilli and Candida increased, acid-sensitive microorganisms decreased, and the caries prevalence was low.
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| 2. |
- Almståhl, Annica, 1973, et al.
(författare)
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Explorative study on quality of life in relation to salivary secretion rate in head and neck cancer patients treated with radiotherapy.
- 2016
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Ingår i: Head & neck. - : Wiley. - 1097-0347 .- 1043-3074. ; 38:5, s. 782-791
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Tidskriftsartikel (refereegranskat)abstract
- Background: Radiation therapy (RT) to the head and neck (H&N) region often results in oral complications. In this explorative study, the pretreatment and posttreatment (6 months and 12 months) quality of life (QoL) was analysed for patients with H&N cancer. The associations between QoL and salivary secretion rates were analysed. Methods: In 29 patients (19 men and 10 women, mean age 59±8 years), the stimulated whole salivary secretion and buccal minor gland secretion were measured. The patients completed the European Organisation for Research and Treatment of Cancer Quality of Life questionnaires (QLQ-C30 and H&N35) and the Hospital Anxiety and Depression scale (HADS). Results: One year after the completion of radiotherapy, subjects with hyposalivation (≤ 0.7 ml/min) reported clinically meaningful, but not statistically significant differences, in cognitive functioning, insomnia, swallowing, social eating, dry mouth, sticky saliva and use of painkillers. Statistically significant differences were found for emotional functioning, sticky saliva and dyspnea (p<0.05). Thirtythree percent of them had a HADS score suggesting anxiety problems compared to 8% for those with whole stimulated salivary secretion rates > 0.7 ml/min. Conclusion: Radiotherapy in the H&N region, also using intensity-modulated radiotherapy, is associated with many aspects of life such as cognitive functioning, insomnia, dry mouth and sticky saliva, especially for those with hyposalivation. This article is protected by copyright. All rights reserved.
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| 3. |
- Almståhl, Annica, 1973, et al.
(författare)
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Explorative study on quality of life in relation to salivary secretion rate in head and neck cancer patients treated with radiotherapy up to 2 years post treatment.
- 2019
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Ingår i: International journal of dental hygiene. - : Wiley. - 1601-5037 .- 1601-5029. ; 17:1, s. 46-54
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to analyse quality of life (QoL) pretreatment and up to 24months post radiation therapy (RT) in patients with head and neck (H&N) cancer.Twenty-nine patients (19 men and 10 women) with a mean age of 59±8years were included. The stimulated salivary secretion was measured and the patients completed the European Organisation for Research and Treatment of Cancer Quality of Life questionnaires (EORTC QLQ-C30 and H&N35) and the Hospital Anxiety and Depression scale (HADS) pretreatment and at 6, 12 and 24months post RT.At all time-points after RT (6, 12, and 24months), patients with hyposalivation (stimulated secretion rate ≤0.7mL/min) reported clinically significant differences (> 10 points) regarding insomnia, swallowing, social eating, dry mouth, and sticky saliva. Statistically significant differences were found for emotional functioning and insomnia at 12months (P<0.05 for both) and for sticky saliva at both 12 and 24months (P<0.05 and P<0.01). The number of clinically significant differences increased from 10 at both 6 and 12months post-RT to 14 functioning/symptom scales and single items at the 24months follow-up. At 24months post RT, 21% of patients with hyposalivation had HADS scores suggesting anxiety problems compared to 7% for those with stimulated salivary secretion rates >0.7mL/min.Patients with hyposalivation showed deterioration in health related quality of life (QoL) at 24months compared with 12months post RT. Most pronounced were problems with insomnia, swallowing, social eating, dry mouth, and sticky saliva.
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| 4. |
- Almståhl, Annica, 1973, et al.
(författare)
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Mucosal microflora in head and neck cancer patients
- 2018
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Ingår i: International Journal of Dental Hygiene. - : Wiley. - 1601-5029. ; 16:4, s. 459-466
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To analyse the tongue and buccal microflora prospectively in head and neck cancer patients treated with radiation therapy (RT). Methods: In 33 dentate patients, microbial samples from the tongue and buccal mucosa were collected pretreatment, during treatment, and 6 months, 1 year and 2 years post-treatment. Microorganisms associated with oral health and oral disorders were analysed using cultivation technique. Oral mucositis was scored at the appointment during treatment. Results: Compared with pretreatment, lactobacilli and Candida increased on the tongue, while streptococci and Neisseria decreased during treatment. Two years post-treatment, Neisseria and Prevotella were decreased and Candida increased. On the buccal mucosa, an increased growth of lactobacilli and increased detection frequencies of the opportunistic bacteria Staphylococcus aureus, Gram-negative enteric rods and enterococci were seen during treatment compared with pretreatment. Seventy per cent showed severe mucositis during treatment. Two years post-treatment the total count as well as streptococci, Neisseria and Fusobacterium nucleatum were decreased and lactobacilli increased compared with pretreatment. Conclusion: Despite improvements in treatment for cancer in the head and neck region, microorganisms associated with oral health decrease during treatment and mucosal pathogens increase. Two years post-treatment, levels of acid-tolerant (lactobacilli and Candida) were increased, while acid-sensitive microorganisms (Neisseria and F.nucleatum) were decreased, plausibly due to persisting decreased salivary secretion rate.
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| 5. |
- Beasley, W., et al.
(författare)
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Image-based Data Mining to Probe Dosimetric Correlates of Radiation-induced Trismus
- 2018
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Ingår i: International Journal of Radiation Oncology Biology Physics. - : Elsevier BV. - 0360-3016. ; 102:4, s. 1330-1338
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To identify imaged regions in which dose is associated with radiation-induced trismus after head and neck cancer radiation therapy (HNRT) using a novel image-based data mining (IBDM) framework. Methods and Materials: A cohort of 86 HNRT patients were analyzed for region identification. Trismus was characterized as a continuous variable by the maximum incisor-to-incisor opening distance (MID) at 6 months after radiation therapy. Patient anatomies and dose distributions were spatially normalized to a common frame of reference using deformable image registration. IBDM was used to identify clusters of voxels associated with MID (P <= .05 based on permutation testing). The result was externally tested on a cohort of 35 patients with head and neck cancer. Internally, we also performed a dose-volume histogram-based analysis by comparing the magnitude of the correlation between MID and the mean dose for the IBDM-identified cluster in comparison with 5 delineated masticatory structures. Results: A single cluster was identified with the IBDM approach (P < .01), partially overlapping with the ipsilateral masseter. The dose-volume histogram-based analysis confirmed that the IBDM cluster had the strongest association with MID, followed by the ipsilateral masseter and the ipsilateral medial pterygoid (Spearman's rank correlation coefficients: R-s = -0.36, -0.35, -0.32; P = .001, .001, .002, respectively). External validation confirmed an association between mean dose to the IBDM cluster and MID (R-s = -0.45; P = .007). Conclusions: IBDM bypasses the common assumption that dose patterns within structures are unimportant. Our novel IBDM approach for continuous outcome variables successfully identified a cluster of voxels that are highly associated with trismus, overlapping partially with the ipsilateral masseter. Tests on an external validation cohort showed an even stronger correlation with trismus. These results support use of the region in HNRT treatment planning to potentially reduce trismus. (C) 2018 Elsevier Inc. All rights reserved.
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| 6. |
- Bergström, Liza, 1974, et al.
(författare)
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Community listeners' perceptions of voice function post-radiotherapy for laryngeal cancer.
- 2018
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Ingår i: International Journal of Speech-Language Pathology. - : Informa UK Limited. - 1754-9507 .- 1754-9515. ; 20:5, s. 494-501
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Tidskriftsartikel (refereegranskat)abstract
- Successful communication is influenced by communication partners, the community and communication environment. This study examines community members' perceptions of voice function following laryngeal cancer management compared to ratings by clinicians and patients.Sixty-six (Tis-T3) laryngeal cancer patients post-radiotherapy, 10 community members and three speech-language pathologists (clinicians) were recruited. Patients completed voice recordings and self-rated voice quality and acceptability, six months post-radiotherapy. Community members and clinicians rated patient voice recordings using (a) Voice Quality/Acceptability questionnaire, (b) Communicative Suitability Scale (voice function in different vocally demanding environments) and (c) a gender perception question.Ratings for voice quality differed significantly (p<0.001) between community members and clinicians and approached significance (p=0.08) between community members and patients. No significant difference for voice acceptability was noted between community members and clinicians/patients. Community members rated the irradiated voice significantly different (p≤0.02) across communication environments with more vocally demanding environments being rated as "Barely Sufficient". Incorrect sex identification (gender perception) occurred with 25% of females.Community communication partners identify functional voice impairments post-radiotherapy, particularly across more vocally demanding environments and for female speakers. Implications for voice rehabilitation including appropriate patient selection is highlighted.
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| 7. |
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| 8. |
- Bergström, Liza, 1974, et al.
(författare)
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Voice rehabilitation after laryngeal cancer: Associated effects on psychological well-being
- 2017
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Ingår i: Supportive Care in Cancer. - : Springer Science and Business Media LLC. - 0941-4355 .- 1433-7339. ; 25:9, s. 2683-2690
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Tidskriftsartikel (refereegranskat)abstract
- Purpose Psychological distress after laryngeal cancer treatment is prevalent. Although voice rehabilitation has shown to improve functional outcomes and positively affect health-related quality of life, to date, there has been limited study of the associated effect of behavioural voice intervention on psychological well-being/distress post laryngeal cancer. Method Sixty-three patients with Tis-T4 laryngeal cancer treated with (chemo)radiotherapy were prospectively recruited and randomised to either a voice rehabilitation (VR, n = 31) or control group (n = 32). The VR group received 10 speech pathology sessions consisting of both direct and indirect voice intervention post (chemo)radiotherapy. The control group received general voice education but not specific intervention. As part of a multidisciplinary assessment battery, psychological well-being/distress was measured using the Hospital Anxiety and Depression Scale (HADS) pre, six and 12 months post VR. Results Within-group analysis revealed a significant (p = 0.03) reduction in the proportion of patients with anxiety in the VR group between baseline and 12 months. No change over time was observed in controls. Between-group analysis revealed a trend for fewer VR cases demonstrating anxiety (p = 0.06) or depression (p = 0.08) at 6 months and significantly fewer demonstrating anxiety (p = 0.04) and depression (p = 0.04) at 12 months, compared to controls. Significant correlations were observed between patients' voice perceptions and reduced anxiety (r(pb) = -0.38) and depression (r(pb) = -0.66) within the VR group at 12 months. Conclusions The positive correlations and between-group analyses indicate a positive effect on psychological well-being associated with completing voice rehabilitation. Results highlight potential additional benefits of behavioural voice intervention beyond achieving direct change to voice function.
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| 9. |
- Bergström, Liza, 1974, et al.
(författare)
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Voice rehabilitation for laryngeal cancer patients: Functional outcomes and patient perceptions
- 2016
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Ingår i: The Laryngoscope. - : Wiley. - 0023-852X. ; 126:9, s. 2029-2035
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Tidskriftsartikel (refereegranskat)abstract
- Objectives/Hypothesis: Laryngeal cancer and its treatment, despite management with organ-preservation treatments, is known to negatively affect voice and functional outcomes. The aim of this study was to determine whether functional outcomes and patient perceptions were improved by combining organ preservation with post treatment function rehabilitation. Study Design: Randomized controlled trial. Method: Sixty-one patients with carcinoma in situ (Tis) to T4 size laryngeal cancers treated with radiotherapy were prospectively recruited. Thirty patients were randomized into the voice rehabilitation (VR) group and 31 received no VR (control group). The VR group underwent 10 speech pathology sessions postradiotherapy. Voice function was evaluated pre-VR and at 6 and 12 months follow-up using the auditory-perceptual Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale and patient perception measures. Results: The control group demonstrated significant deterioration in vocal roughness (P = 0.02) between 6 to 12 months, whilst the VR group did not, resulting in a significant difference (P < 0.01) between the two groups at 12 months. A between-group significant difference (P = 0.02) was also observed for breathiness at 12 months. Patient perceptions of improved vocal quality, acceptability, hoarseness, vocal fatigue, and ashamed (of voice) pre- to post-VR improved significantly (P < 0.02) in the VR group, although significant difference (P = 0.03) between groups was observed post-VR for hoarseness only. Conclusion: For this study group representing Tis to T4-size laryngeal cancers, patients receiving voice rehabilitation post radiotherapy demonstrated no functional decline in vocal roughness and perceived their voice to improve to a greater extent post-VR than the control group. Level of Evidence: 1b. Laryngoscope, 126:2029–2035, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.
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| 10. |
- Hedström, Anna, 1983, et al.
(författare)
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Identifying organs at risk for radiation-induced late dysphagia in head and neck cancer patients.
- 2019
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Ingår i: Clinical and translational radiation oncology. - : Elsevier BV. - 2405-6308. ; 19, s. 87-95
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Tidskriftsartikel (refereegranskat)abstract
- Dysphagia is a common, severe and dose-limiting toxicity after oncological treatment of head and neck cancer (HNC). This study aims to investigate relationships between radiation doses to structures involved in normal swallowing and patient-reported as well as clinically measured swallowing function in HNC patients after curative (chemo-) radiation therapy (RT) with focus on late effects.Patients (n=90) with HNC curatively treated with RT±chemotherapy in 2007-2015 were assessed for dysphagia post-treatment by telephone interview and videofluoroscopy (VFS). A study-specific symptom score was used to determine patient-reported dysphagia. The Penetration-Aspiration Scale (PAS) was applied to determine swallowing function by VFS (PAS≥4/≥6=moderate/severe dysphagia). Thirteen anatomical structures involved in normal swallowing were individually delineated on the patients' original planning CT scans and associated dose-volume histograms (DVHs) retrieved. Relationships between structure doses and late toxicity were investigated through univariable and multivariable logistic regression analysis (UVA/MVA) accounting for effects by relevant clinical factors.Median assessment time was 7months post-RT (range: 5-34months). Mean dose to the contralateral parotid gland and supraglottic larynx as well as maximum dose to the contralateral anterior digastric muscle predicted patient-reported dysphagia (AUC=0.64-0.67). Mean dose to the pharyngeal constrictor muscle, the larynx, the supraglottic larynx and the epiglottis, as well as maximum dose to the contralateral submandibular gland predicted moderate and severe dysphagia by VFS (AUC=0.71-0.80).The patients in this cohort were consecutively identified pre-treatment, and were structurally approached and assessed for dysphagia after treatment at a specific time point. In addition to established dysphagia organs-at-risk (OARs), our data suggest that epiglottic and submandibular gland doses are important for swallowing function post-RT. Keeping DVH thresholds below V60=60% and V60=17%, respectively, may increase chances to reduce occurrence of severe late dysphagia. The results need to be externally validated in future studies.
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