Joaquin E Jimenez1, Marci Lee Nilsen2, William E Gooding3, Jennifer L Anderson1, Nayel I Khan1, Leila J Mady4, Tamara Wasserman-Wincko1, Umamaheswar Duvvuri1, Seungwon Kim1, Robert L Ferris5, Mario G Solari6, Mark W Kubik6, Jonas T Johnson1, Shaum Sridharan7. 1. Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States. 2. Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States; University of Pittsburgh, School of Nursing, Department of Acute and Tertiary Care, United States. 3. Biostatistics Facility, UPMC Hillman Cancer Center, United States. 4. Department of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, University of Pennsylvania, United States. 5. Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States; UPMC Hillman Cancer Center, United States. 6. Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States; Department of Plastic Surgery, University of Pittsburgh Medical Center, United States. 7. Department of Otolaryngology - Head & Neck Surgery, University of Pittsburgh Medical Center, United States; Department of Plastic Surgery, University of Pittsburgh Medical Center, United States. Electronic address: sridharans2@upmc.edu.
Abstract
OBJECTIVES: To determine which surgical factors are associated with quality-of-life (QOL) outcomes in oral cavity cancer survivors after free flap reconstruction of the oral cavity. PATIENTS AND METHODS: A cross-sectional study was conducted from a multidisciplinary head and neck cancer (HNC) survivorship clinic. Oral cavity cancer survivors with at least 6-months of postoperative follow-up from ablation and free flap reconstruction were included. Primary outcome measures were validated patient-reported outcome measures (PROMs) including the Eating Assessment Tool-10 (EAT-10) measure of swallowing-specific QOL, University of Washington Quality of Life (UW-QOL) physical and social-emotional subscale scores and feeding tube dependence. RESULTS: Extent of tongue resection was associated with EAT-10 and the UW-QOL Physical subscale scores. Patients with oral tongue defects reported worse scores than with composite defects in the EAT-10 and UW-QOL physical domain (p = 0.0004, 0.0025, respectively). This association no longer applies when controlling for differences in extent of tongue resection. Patients with anterior composite resections reported worse EAT-10 scores than lateral resections (p = 0.024). This association no longer applies when controlling for extent of tongue resection (p = 0.46). Gastric tube dependence demonstrates similar trends to PROMs. CONCLUSION: Extent of tongue resection was strongly associated with poor QOL outcomes after free tissue reconstruction of the oral cavity and mediates the associations between other defect characteristics and QOL. These findings demonstrate the need for emphasis on expected oral tongue defects when counseling patients and highlight the need to address QOL in a multidisciplinary fashion post-operatively.
OBJECTIVES: To determine which surgical factors are associated with quality-of-life (QOL) outcomes in oral cavity cancer survivors after free flap reconstruction of the oral cavity. PATIENTS AND METHODS: A cross-sectional study was conducted from a multidisciplinary head and neck cancer (HNC) survivorship clinic. Oral cavity cancer survivors with at least 6-months of postoperative follow-up from ablation and free flap reconstruction were included. Primary outcome measures were validated patient-reported outcome measures (PROMs) including the Eating Assessment Tool-10 (EAT-10) measure of swallowing-specific QOL, University of Washington Quality of Life (UW-QOL) physical and social-emotional subscale scores and feeding tube dependence. RESULTS: Extent of tongue resection was associated with EAT-10 and the UW-QOL Physical subscale scores. Patients with oral tongue defects reported worse scores than with composite defects in the EAT-10 and UW-QOL physical domain (p = 0.0004, 0.0025, respectively). This association no longer applies when controlling for differences in extent of tongue resection. Patients with anterior composite resections reported worse EAT-10 scores than lateral resections (p = 0.024). This association no longer applies when controlling for extent of tongue resection (p = 0.46). Gastric tube dependence demonstrates similar trends to PROMs. CONCLUSION: Extent of tongue resection was strongly associated with poor QOL outcomes after free tissue reconstruction of the oral cavity and mediates the associations between other defect characteristics and QOL. These findings demonstrate the need for emphasis on expected oral tongue defects when counseling patients and highlight the need to address QOL in a multidisciplinary fashion post-operatively.
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