Oral oncology
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Randomized Controlled Trial
Randomized double-blind placebo-controlled trial of celecoxib for oral mucositis in patients receiving radiation therapy for head and neck cancer.
Oral mucositis (OM) is a painful complication of radiation therapy (RT) for head and neck cancer (H&NC). OM can compromise nutrition, require opioid analgesics and hospitalization for pain control, and lead to treatment interruptions. Based on the role of inflammatory pathways in OM pathogenesis, we investigated effect of cyclooxygenase-2 (COX-2) inhibition on severity and morbidity of OM. ⋯ Daily use of a selective COX-2 inhibitor, during period of RT for H&NC, did not reduce the severity of clinical OM, pain, dietary compromise or use of opioid analgesics. These findings also have implications for celecoxib use in H&NC treatment regimens (NCT00698204).
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Nasopharyngeal carcinoma (NPC) is endemic in Southern China, and the South-East Asia including Hong Kong. We still see patients recur after primary treatment with radiotherapy or chemo-irradiation. Management of nasopharyngeal carcinoma remains one of the biggest clinical challenges. ⋯ Furthermore, as NPC is tightly associated with the Epstein-Barr virus (EBV) infection, the role of tumor-associated viral antigens in NPC renders it an appealing candidate for cellular immunotherapy. This is a review of recent evolving concerted efforts and the success from our translational research with focus of the recent systemic novel targeted therapies including the potential role of immunotherapy which may offer further clinical benefit to our patients living with NPC. The scientific basis and latest published results of the relevant clinical trials are highlighted, demonstrating the ongoing battle against NPC is indeed one of the most fascinating successes in head and neck oncology.
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Painful mucositis is one of the most distressing toxicities of chemoradiotherapy (CRT) for head and neck cancer (HNC), with the characteristics of incidental predictable breakthrough pain (BTP) during swallowing. Fentanyl pectin nasal spray (FPNS) could be a good therapeutic option. ⋯ FPNS demonstrated activity against BTP when swallowing in HNC patients. These data should be considered as hypothesis-generating.
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Comparative Study
Validation of a one-page patient-reported Charlson comorbidity index questionnaire for upper aerodigestive tract cancer patients.
Cancer patients have a wide range of comorbidities that are important confounders for biomarker and clinical studies of prognosis and outcome. Comorbidities can be captured using the Charlson Comorbidity Index (CCI) through abstraction of medical records, but patient-reported outcome (PRO) questionnaires have also been used. The objective was to validate the PRO-CCI in a head and neck cancer (HNC) population, and to assess its level of agreement with the standard (std-CCI) method of chart review. ⋯ PRO-CCI can be an easy and effective tool in prognostic and outcomes research in HNC patients.
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To evaluate long-term changes in health related quality of life (HRQOL) in oral/oropharyngeal cancer survivors and their need for and use of supportive care. ⋯ A range of HRQOL domains in head and neck cancer survivors were deteriorated in the long-term compared to baseline and to the first year after treatment. At time of treatment and less frequently at long-term follow up, patients reported needing and using a variety of supportive care services.