Speech-language pathology care and short- and long-term outcomes of oropharyngeal cancer treatment in the elderly

Objective

To examine associations between speech-language pathology (SLP) care and pretreatment variables, short-term and long-term swallowing and airway impairment, and survival in elderly patients treated for oropharyngeal squamous cell cancer (SCCA).

Study Design

Retrospective analysis of Surveillance, Epidemiology, and End Results-Medicare data.

Methods

We evaluated longitudinal data from 666 patients diagnosed with oropharyngeal SCCA from 2004 to 2007 using cross-tabulations, multivariate logistic regression, and survival analysis.

Results

SLP care was documented in 25% of patients. High-volume hospital care (odds ratio (OR) = 3.2 [1.0–10.0]) and dysphagia during treatment (OR = 13.0 [3.6–47.1]) were the only significant predictors of SLP care during the initial treatment period. SLP care was significantly more likely during the first year (OR = 5.3 [3.1–9.1]) and second year (OR = 4.5 [2.4–8.2]) following initial treatment. Subsequent dysphagia (OR = 32.5 [16.9–62.4]), stricture (OR = 2.2 [1.2–4.0]), gastrostomy (OR = 1.7 [1.1–2.7]), and tracheostomy tube use (OR = 2.4 [1.2–4.8]) were significantly associated with long-term SLP care. After controlling for patient, tumor, and treatment-related variables, SLP care was associated with significant relative attenuation of the OR for dysphagia (93%), stricture (35%), weight loss (8%), and airway obstruction (34%). Survival analysis, controlling for all other variables, demonstrated improved survival for patients under SLP care (hazard ratio = 0.73 [0.57–0.95]).

Conclusion

SLP care is underutilized in elderly oropharyngeal SCCA patients and largely utilized after the onset of impaired airway and swallowing function, but is associated with improved outcomes. These data suggest a need for treatment guidelines that incorporate the routine use of SLP care in this population during the initial treatment period and beyond.

Level of Evidence

2c. Laryngoscope, 2017

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Successful treatment of refractory cholinergic urticaria with omalizumab

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A 71-year-old man with a hemorrhagic vesicular eruption

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Psoriasis and small intestine bacterial overgrowth

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Dermoscopic features of Orf disease

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Support needs of people living with Mycobacterium ulcerans (Buruli ulcer) disease in a Ghana rural community: a grounded theory study

Abstract

Introduction/Background

Mycobacterium ulcerans (also known as Buruli ulcer) disease is a rare skin disease which is prevalent in rural communities in the tropics mostly in Africa. Mortality rate is low, yet morbidity and consequent disabilities affect the quality of life of sufferers.

Aims

The aim of this paper is to use the grounded theory method to explore the support needs of people living with the consequences of Buruli ulcer in an endemic rural community in Ghana.

Methods

We used the grounded theory research approach to explore the experiences of people living with Mycobacterium ulcerans in a rural district in Ghana and provide a basis to understand the support needs of this group.

Results

The key support needs identified were: functional limitations, fear and frequency of disease recurrence, contracture of limbs and legs, loss of sensation and numbness in the affected body area, lack of information from health professionals about self-care, feeling tired all the time, insomnia, lack of good diet, lack of access to prostheses, having to walk long distances to access health services, and loss of educational opportunities.

Discussions

The study discusses how the systematically derived qualitative data has helped to provide a unique insight and advance our understanding of the support needs of people living with BU and how they live and attempt to adapt their lives with disability. We discuss how the availability of appropriate interventions and equipment could help them self-manage their condition and improve access to skin care services.

Conclusions

The support needs of this vulnerable group were identified from a detailed analysis of how those living with BU coped with their lives. A key issue is the lack of education to assist self-management and prevent deterioration. Further research into the evaluation of interventions to address these support needs is necessary including self-management strategies.

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Reply to correspondence ‘Topical ionic contra viral therapy comprised of digoxin and furosemide as a potential novel treatment approach for common warts’

We appreciate Dr Abdelmaksoud's thorough review of our manuscript (1) and would like to reply to the comments that were raised with this letter. First, it appears that the understanding is that the study describes the 'clinical response of common warts to a topical application of a fixed dose of 980 mg of the ICVT gel on the patients' lower back. It should be clarified that the main objective of this first-in-man study was evaluate the systemic exposure, safety and tolerability of ionic-contra-viral therapy (ICVT) (2).

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