Effect of Radiotherapy on Functional and Health-Related Quality of Life Outcomes after Jaw Reconstruction

Simple Summary Reconstructive surgery is critical to restore form and function after treatment for head and neck cancer (HNC). The aim of this cross-sectional study was to describe long-term quality of life (QoL) and functional outcomes among patients with a history of HNC who underwent reconstruction of the mandible and/or maxilla. Patients who had radiotherapy either before or after their index reconstruction reported significantly worse functional and QoL outcomes, including speech, swallowing, eating and drinking, appearance, smiling, and satisfaction with information. Swallowing, salivation, oral competence, and satisfaction with information worsened with increasing time since surgery. Women and younger patients also reported worse functional and QoL outcomes, especially speech and facial aesthetics. Understanding long-term outcomes of jaw reconstruction is important for both patients and clinicians to make evidence-based decisions about treatment options. We have identified several groups at risk of poorer outcomes that may benefit from enhanced pre-operative counselling and post-operative monitoring. Abstract Long-term health-related quality of life (HRQOL) and functional outcomes following mandibular and maxillary reconstruction are lacking. To determine these outcomes, a cross-sectional study of patients with a history of cancer who underwent jaw reconstruction was undertaken. Participants were identified from a database of jaw reconstruction procedures at the Chris O’Brien Lifehouse (Sydney, Australia). Eligible patients had at least one month follow-up, were aged ≥18 years at surgery, and had history of malignancy. HRQOL was measured using the FACE-Q Head and Neck Cancer Module (FACE-Q H&N). Functional outcomes were measured using the FACE-Q H&N, MD Anderson Dysphagia Inventory (MDADI) and Speech Handicap Index (SHI). Ninety-seven questionnaires were completed (62% response rate). Mean age of respondents was 63.7 years, 61% were male, and 64% underwent radiotherapy. Treatment with radiotherapy was associated with worse outcomes across 10/14 FACE-Q H&N scales, three MDADI subscales and one composite score, and the SHI. Mean differences in scores between irradiated and non-irradiated patients exceeded clinically meaningful differences for the MDADI and SHI. Issues with oral competence, saliva, speaking, and swallowing worsened with increasing time since surgery. Younger patients reported greater concerns with appearance, smiling, speaking, and cancer worry. Women reported greater concerns regarding appearance and associated distress. History of radiotherapy substantially impacts HRQOL and function after jaw reconstruction. Age at surgery and gender were also predictors of outcomes and associated distress. Pre-treatment counselling of patients requiring jaw reconstruction may lead to improved survivorship for patients with head and neck cancer.

[1]  R. Seth,et al.  Patient-Reported Aesthetic and Psychosocial Outcomes After Microvascular Reconstruction for Head and Neck Cancer. , 2021, JAMA otolaryngology-- head & neck surgery.

[2]  Giulia Elia,et al.  Long-term functional outcomes and quality of life after partial glossectomy for T2 squamous cell carcinomas , 2021, Brazilian journal of otorhinolaryngology.

[3]  Jonathan R. Clark,et al.  Support group preferences for patients with head and neck cancer: cross-sectional survey , 2021 .

[4]  S. Barclay,et al.  Osteoradionecrosis after treatment of head and neck cancer: A comprehensive analysis of risk factors with a particular focus on role of dental extractions , 2021 .

[5]  R. Sasaki,et al.  Risk factors for osteoradionecrosis of the jaw in patients with head and neck squamous cell carcinoma , 2020, Radiation oncology.

[6]  C. R. Leemans,et al.  Head and neck squamous cell carcinoma , 2020, Nature Reviews Disease Primers.

[7]  A. Hope,et al.  The utility of postoperative radiotherapy in intermediate-risk oral squamous cell carcinoma. , 2020, International journal of oral and maxillofacial surgery.

[8]  Abi Miller.  Returning to work after head and neck cancer. , 2020, Current opinion in otolaryngology & head and neck surgery.

[9]  Yi-Jun Kim,et al.  Increasing incidence and improving survival of oral tongue squamous cell carcinoma , 2020, Scientific Reports.

[10]  A. Rossi,et al.  Patient-reported Aesthetic Satisfaction following Facial Skin Cancer Surgery Using the FACE-Q Skin Cancer Module , 2019, Plastic and reconstructive surgery. Global open.

[11]  C. Hansen,et al.  Osteoradionecrosis of the mandible after radiotherapy for head and neck cancer: risk factors and dose-volume correlations , 2019, Acta oncologica.

[12]  Jonathan R. Clark,et al.  Depth of invasion alone as an indication for postoperative radiotherapy in small oral squamous cell carcinomas: An International Collaborative Study , 2019, Head & neck.

[13]  D. Young-Afat,et al.  Leveraging patient‐reported outcomes data to inform oncology clinical decision making: Introducing the FACE‐Q Head and Neck Cancer Module , 2018, Cancer.

[14]  O. Colhoun,et al.  Module , 2019, Springer Reference Medizin.

[15]  N. Futran.  Multiple-Flap Reconstruction of Head and Neck Defects. , 2018, JAMA otolaryngology-- head & neck surgery.

[16]  S. Kaasa,et al.  Supportive care in cancer: new directions to achieve universal access to psychosocial, palliative, and end-of-life care , 2018 .

[17]  N. Boyd,et al.  Predictive factors for osteoradionecrosis of the jaws: A retrospective study , 2018, Head & neck.

[18]  B. O'Sullivan,et al.  Osteoradionecrosis of the mandible in patients with oropharyngeal carcinoma treated with intensity‐modulated radiotherapy , 2017, Cancer.

[19]  L. Marks,et al.  Incidence of, and risk factors for, mandibular osteoradionecrosis in patients with oral cavity and oropharynx cancers. , 2017, Oral oncology.

[20]  T. Komori,et al.  Relationship between dental status and development of osteoradionecrosis of the jaw: a multicenter retrospective study. , 2017, Oral surgery, oral medicine, oral pathology and oral radiology.

[21]  Jonathan R. Clark,et al.  Postoperative radiotherapy for patients with oral squamous cell carcinoma with intermediate risk of recurrence: A case match study , 2017, Head & neck.

[22]  Jonathan R. Clark,et al.  Education and support needs in patients with head and neck cancer: A multi‐institutional survey , 2017, Cancer.

[23]  J. Cartwright,et al.  The health professionals’ perspectives of support needs of adult head and neck cancer survivors and their families: a Delphi study , 2017, Supportive Care in Cancer.

[24]  Ryan S. Lee,et al.  The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): The Memorial Sloan Kettering Cancer Center experience. , 2017, Oral oncology.

[25]  J. Lewin,et al.  What is a clinically relevant difference in MDADI scores between groups of head and neck cancer patients? , 2016, The Laryngoscope.

[26]  H. Mehanna,et al.  Reconstructive considerations in head and neck surgical oncology: United Kingdom National Multidisciplinary Guidelines , 2016, The Journal of Laryngology & Otology.

[27]  Shu Guo,et al.  Functional Assessments in Patients Undergoing Radial Forearm Flap Following Hemiglossectomy , 2016, The Journal of craniofacial surgery.

[28]  Amy Y. Chen,et al.  The Development and Validation of a Dysphagia-Specific Quality-of-Life Questionnaire for Patients With Head and Neck Cancer , 2016 .

[29]  M. Hanasono.  Reconstructive Surgery for Head and Neck Cancer Patients , 2014, Advances in medicine.

[30]  A. Garden,et al.  Evaluating the impact of patient, tumor, and treatment characteristics on the development of jaw complications in patients treated for oral cancers: A SEER–Medicare analysis , 2013, Head & neck.

[31]  D. Okay,et al.  Quality of life after management of advanced osteoradionecrosis of the mandible. , 2013, International journal of oral and maxillofacial surgery.

[32]  Jonathan R. Clark,et al.  Close margin alone does not warrant postoperative adjuvant radiotherapy in oral squamous cell carcinoma , 2013, Cancer.

[33]  T. Nakatsuka,et al.  Clinical factors associated with postoperative complications and the functional outcome in mandibular reconstruction , 2013, Microsurgery.

[34]  A. Garden,et al.  Osteoradionecrosis and radiation dose to the mandible in patients with oropharyngeal cancer. , 2013, International journal of radiation oncology, biology, physics.

[35]  S. Rogers,et al.  Systematic review of the current evidence in the use of postoperative radiotherapy for oral squamous cell carcinoma. , 2012, The British journal of oral & maxillofacial surgery.

[36]  B. Schmidt,et al.  Quality of life for patients requiring surgical resection and reconstruction for mandibular osteoradionecrosis: 10‐year experience at the university of California San Francisco , 2012, Head & neck.

[37]  N. Samman,et al.  Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. , 2012, Oral surgery, oral medicine, oral pathology and oral radiology.

[38]  Y. S. Shin,et al.  Radiotherapy deteriorates postoperative functional outcome after partial glossectomy with free flap reconstruction. , 2012, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[39]  R. Torta,et al.  Functional and psychological evaluation after flap reconstruction plus radiotherapy in oral cancer , 2011, Head & neck.

[40]  H. Brenner,et al.  Changes in survival in head and neck cancers in the late 20th and early 21st century: a period analysis. , 2010, The oncologist.

[41]  Neil K. Aaronson,et al.  Speech Handicap Index in patients with oral and pharyngeal cancer: Better understanding of patients' complaints , 2008, Head & neck.

[42]  S. Pocock,et al.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. , 2007, Preventive medicine.

[43]  G. Funk,et al.  Patient-reported factors associated with discontinuing employment following head and neck cancer treatment. , 2007, Archives of otolaryngology--head & neck surgery.

[44]  M. McGurk,et al.  How satisfied are head and neck cancer (HNC) patients with the information they receive pre-treatment? Results from the satisfaction with cancer information profile (SCIP). , 2006 .

[45]  R. Newell,et al.  The information needs of head and neck cancer patients prior to surgery. , 2004, Annals of the Royal College of Surgeons of England.

[46]  R. Frankowski,et al.  The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. , 2001, Archives of otolaryngology--head & neck surgery.

[47]  M. Dropkin.  Body image and quality of life after head and neck cancer surgery. , 1999, Cancer practice.

[48]  S. Taylor.  Head and neck cancer. , 1991, Cancer chemotherapy and biological response modifiers.