Christopher W Noel1,2,3, Yue Jennifer Du1, Elif Baran1, David Forner2,4, Zain Husain5, Kevin M Higgins6, Irene Karam5, Kelvin K W Chan7, Julie Hallet2,3,8, Frances Wright2,6, Natalie G Coburn2,3,8,9, Antoine Eskander1,2,3,8, Lesley Gotlib Conn2,8. 1. Department of Otolaryngology-Head and Neck Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 2. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 3. ICES, Toronto, Ontario, Canada. 4. Division of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. 5. Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 6. Department of Surgical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 7. Department of Medical Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 8. Evaluative Clinical Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 9. Ontario Health Cancer Care, Toronto, Ontario, Canada.
Abstract
IMPORTANCE: Patients with head and neck cancer manage a variety of symptoms at home on an outpatient basis. Clinician review alone often leaves patient symptoms undetected and untreated. Standardized symptom assessment using patient-reported outcomes (PROs) has been shown in randomized clinical trials to improve symptom detection and overall survival, although translation into real-world settings remains a challenge. OBJECTIVE: To better understand how patients with head and neck cancer cope with cancer-related symptoms and to examine their perspectives on standardized symptom assessment. DESIGN, PARTICIPANTS, AND SETTING: This was a qualitative analysis using semistructured interviews of patients with head and neck cancer and their caregivers from November 2, 2020, to April 16, 2021, at a regional tertiary center in Canada. Purposive sampling was used to recruit a varied group of participants (cancer subsite, treatment received, sociodemographic factors). Drawing on the Supportive Care Framework, a thematic approach was used to analyze the data. Data analysis was performed from November 2, 2020, to August 2, 2021. MAIN OUTCOMES AND MEASURES: Patient perception of ambulatory symptom management and standardized symptom assessment. RESULTS: Among 20 participants (median [range] age, 59.5 [33-74] years; 9 [45%] female; 13 [65%] White individuals), 4 themes were identified: (1) timely physical symptom management, (2) information as a tool for symptom management, (3) barriers to psychosocial support, and (4) external factors magnifying symptom burden. Participants' perceptions of standardized symptom assessment varied. Some individuals described the symptom monitoring process as facilitating self-reflection and symptom detection. Others felt disempowered by the process, particularly when symptom scores were inconsistently reviewed or acted on. CONCLUSIONS AND RELEVANCE: This qualitative analysis provides a novel description of head and neck cancer symptom management from the patient perspective. The 4 identified themes and accompanying recommendations serve as guides for enhanced symptom monitoring.
IMPORTANCE: Patients with head and neck cancer manage a variety of symptoms at home on an outpatient basis. Clinician review alone often leaves patient symptoms undetected and untreated. Standardized symptom assessment using patient-reported outcomes (PROs) has been shown in randomized clinical trials to improve symptom detection and overall survival, although translation into real-world settings remains a challenge. OBJECTIVE: To better understand how patients with head and neck cancer cope with cancer-related symptoms and to examine their perspectives on standardized symptom assessment. DESIGN, PARTICIPANTS, AND SETTING: This was a qualitative analysis using semistructured interviews of patients with head and neck cancer and their caregivers from November 2, 2020, to April 16, 2021, at a regional tertiary center in Canada. Purposive sampling was used to recruit a varied group of participants (cancer subsite, treatment received, sociodemographic factors). Drawing on the Supportive Care Framework, a thematic approach was used to analyze the data. Data analysis was performed from November 2, 2020, to August 2, 2021. MAIN OUTCOMES AND MEASURES: Patient perception of ambulatory symptom management and standardized symptom assessment. RESULTS: Among 20 participants (median [range] age, 59.5 [33-74] years; 9 [45%] female; 13 [65%] White individuals), 4 themes were identified: (1) timely physical symptom management, (2) information as a tool for symptom management, (3) barriers to psychosocial support, and (4) external factors magnifying symptom burden. Participants' perceptions of standardized symptom assessment varied. Some individuals described the symptom monitoring process as facilitating self-reflection and symptom detection. Others felt disempowered by the process, particularly when symptom scores were inconsistently reviewed or acted on. CONCLUSIONS AND RELEVANCE: This qualitative analysis provides a novel description of head and neck cancer symptom management from the patient perspective. The 4 identified themes and accompanying recommendations serve as guides for enhanced symptom monitoring.
Authors: Christopher W Noel; David Forner; Douglas B Chepeha; Elif Baran; Kelvin K W Chan; Ambica Parmar; Zain Husain; Irene Karam; Julie Hallet; Natalie G Coburn; Antoine Eskander Journal: Oral Oncol Date: 2021-11-11 Impact factor: 5.337
Authors: José L Pereira; Martin R Chasen; Sean Molloy; Heidi Amernic; Michael D Brundage; Esther Green; Serena Kurkjian; Monika K Krzyzanowska; Wenonah Mahase; Omid Shabestari; Reena Tabing; Christopher A Klinger Journal: J Pain Symptom Manage Date: 2015-12-30 Impact factor: 3.612
Authors: Ethan Basch; Allison M Deal; Mark G Kris; Howard I Scher; Clifford A Hudis; Paul Sabbatini; Lauren Rogak; Antonia V Bennett; Amylou C Dueck; Thomas M Atkinson; Joanne F Chou; Dorothy Dulko; Laura Sit; Allison Barz; Paul Novotny; Michael Fruscione; Jeff A Sloan; Deborah Schrag Journal: J Clin Oncol Date: 2015-12-07 Impact factor: 44.544
Authors: Brittany Barber; Jace Dergousoff; Margaret Nesbitt; Nicholas Mitchell; Jeffrey Harris; Daniel O'Connell; David Côté; Vincent Biron; Hadi Seikaly Journal: J Otolaryngol Head Neck Surg Date: 2015-09-18
Authors: Christopher W Noel; Rinku Sutradhar; Lesley Gotlib Conn; David Forner; Wing C Chan; Rui Fu; Julie Hallet; Natalie G Coburn; Antoine Eskander Journal: JAMA Otolaryngol Head Neck Surg Date: 2022-08-01 Impact factor: 8.961