Jan S Lewin

University of Texas MD Anderson Cancer Center, Houston, Texas, United States

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Publications (89)470.22 Total impact

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    ABSTRACT: BACKGROUND The current study was conducted to evaluate long-term disease control, survival, and functional outcomes after surgical and nonsurgical initial treatment for patients with T4 larynx cancer. METHODS Demographics, disease stage, and treatment characteristics were reviewed for 221 sequential patients treated for T4 laryngeal squamous cell cancer at a single institution between 1983 and 2011. Survival and disease control outcomes were calculated. RESULTS The median follow-up time was 47 months (71 months for patients still alive at the time of analysis). The overall 5-year and 10-year overall survival rates were 52% and 29%, respectively, and the corresponding disease-free survival rates were 57% and 48%, respectively. Overall 5-year and 10-year locoregional control rates were 78% and 67%, respectively, and the corresponding rates for freedom from distant metastasis were 76% and 74%, respectively. On both univariate and multivariate analyses, lymph node-positive disease at the time of presentation was associated with overall mortality (P<.0001). Patients treated with laryngectomy followed by postlaryngectomy radiotherapy (161 patients) achieved better initial locoregional control than patients treated with a laryngeal preservation (LP) approach (60 patients) throughout the follow-up period (log-rank P<.007) yet the median overall survival times were equal for both groups (64 months; 95% confidence interval 47-87 months and 38-87 months, respectively [P =.7]). Patients treated with an LP approach had a tracheostomy rate of 45% and an any-event aspiration rate of 23%. Rates of high-grade dysphagia at the time of last follow-up were worse for patients treated with an LP approach (P<.01). CONCLUSIONS Surgery and postoperative radiotherapy can produce substantial long-term cancer control and survival rates for patients with T4 larynx cancer. Caution should be taken when selecting patients for initial nonsurgical treatment because of significant rates of functional impairment despite survival equivalence.
    Cancer 01/2015; 121(10). DOI:10.1002/cncr.29241 · 4.90 Impact Factor
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    ABSTRACT: Objective We sought to describe the presentation of external head and neck lymphedema in patients treated for head and neck cancer and to examine their initial responses to complete decongestive therapy. Study Design Case series with chart review. Setting MD Anderson Cancer Center, Houston, Texas. Subjects and Methods The charts of patients who were evaluated for head and neck cancer at MD Anderson Cancer Center after treatment (January 2007-January 2013) were retrospectively reviewed. Response to complete decongestive therapy was evaluated per changes in lymphedema severity rating or surface tape measures. Predictors of therapy response were examined on the basis of regression models. Results The cases of 1202 patients were evaluated. Most patients (62%) had soft reversible pitting edema (MD Anderson Cancer Center stage 1b). Treatment response was evaluated for 733 patients; 439 (60%) improved after complete decongestive therapy. Treatment adherence independently predicted complete decongestive therapy response (P < .001). Conclusions These data support the effectiveness of a head and neck cancer-specific regimen of lymphedema therapy for cancer patients with external head and neck lymphedema. Our findings suggest that head and neck lymphedema is distinct from lymphedema that affects other sites, thus requiring adaptations in traditional methods of management and measurement.
    Otolaryngology Head and Neck Surgery 11/2014; 152(2). DOI:10.1177/0194599814558402 · 1.72 Impact Factor
  • International journal of radiation oncology, biology, physics 09/2014; 90(1):S540-S541. DOI:10.1016/j.ijrobp.2014.05.1642 · 4.18 Impact Factor
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    ABSTRACT: Objectives: Ototoxic hearing loss associated with intravenous or intra-arterial administration of cisplatin is well documented. However, there is limited data regarding the ototoxic effect of cisplatin when perfused into the abdominal cavity using hyperthermic intraperitoneal chemotherapy (HIPEC). The purpose of this study is to assess and describe ototoxicity in patients treated with HIPEC with cisplatin and sodium thiosulfate for peritoneal surface malignancies. Design: We performed a retrospective chart review (2007–2012) of patients treated for advanced peritoneal malignancies at a tertiary care center using HIPEC with cisplatin and sodium thiosulfate infusion. Thirteen patients (12 males, 1 female) met study criteria. Audiometric thresholds were compared before and after treatment. A 20 dB loss at any single frequency, 10 dB decrease at any two adjacent frequencies, or loss of response at three consecutive test frequencies defined a significant ototoxic change (American Speech-Language-Hearing Association 1994). Results: Despite minimal hearing change in six patients, none of the 13 patients in our study exhibited a significant ototoxic change in hearing sensitivity post HIPEC with cisplatin at any test interval in any test frequency. Conclusions: Our findings represent the first objective assessment of ototoxic effect after HIPEC with cisplatin and sodium thiosulfate infusion. Our results suggest that peritoneal perfusion of cisplatin with intravenous perfusion of sodium thiosulfate is not associated with ototoxic changes in hearing sensitivity. Further investigation of the administration and systemic mechanism of absorption of sodium thiosulfate as a potential protection against cisplatin ototoxicity is needed to confirm these findings.
    Ear and Hearing 08/2014; 35(6). DOI:10.1097/AUD.0000000000000070 · 2.83 Impact Factor
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    ABSTRACT: To evaluate the indications, complications, and device life of the Provox NiD in a large cohort at a tertiary US cancer center. Longitudinal retrospective cohort study. We reviewed the records of patients who used the NiD prosthesis (2005-2011) for general indicators, device life, and complications. One hundred eighty-six patients who used the NiD were included (median follow-up: 21.4 months). The NiD was placed at initial fit in 41 (22%) patients, whereas 145 (78%) tried an NiD after using another type of prosthesis. Most patients used the NiD similarly to an indwelling device. Median NiD device life was significantly longer than that of other nonindwelling prostheses (45 vs. 29 days, P = .0061), and did not significantly differ from that of standard indwelling devices (45 vs. 50 days, P = .4263). Thirty-eight percent (71 of 189) of NiD users had a history of early leakage (<8 weeks) using a different prosthesis before trying the NiD. Among patients with a pre-existing history of early leakage, almost 90% of NiD prostheses outperformed the device life of other products. The NiD prosthesis offers satisfactory device life on a par with indwelling prostheses in our cohort of NiD users. Coupled with favorable published airflow characteristics and satisfactory tracheoesophageal voice, these data suggest that the NiD offers a durable, low-cost prosthetic alternative in contemporary practice. A unique indication for NiD may be improved device life in some patients with a history of early leakage. 4. Laryngoscope, 2013.
    The Laryngoscope 07/2014; 124(7). DOI:10.1002/lary.24488 · 2.03 Impact Factor
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    ABSTRACT: Background: Lower cranial neuropathies are a late effect of radiotherapy, typically reported in nasopharynx cancer survivors. Limited data examine these neuropathies after oropharyngeal cancer, particularly as it relates to late radiation-associated dysphagia (late-RAD).Methods: Two cases were examined over 4 to 6 years. Late-RAD was assessed per MBSImp™©, PAS, PSSHN, and MDADI. Neuropathies were examined via clinical examination and laryngeal videostroboscopy, and compared with trajectories of late-RAD.Results: Media-enriched case reports describe the course of late-RAD and neuropathies in two cases after definitive radiotherapy ± EGFR-inhibitor for oropharynx cancer. Late-RAD was characterized by severe physiologic impairments per MBSImp™© and decreased swallowing-related QOL per MDADI. Trajectories of late-RAD paralleled the progression or stability of neuropathies.Conclusions: Late-RAD with lower cranial neuropathies resulted in profound and persistent functional impairment. Rarely reported, late radiation-associated lower cranial neuropathies may be a major contributor to new-onset or progressive dysphagia in long-term oropharyngeal cancer survivors. Head Neck, 2014
    Head & Neck 07/2014; 37(4). DOI:10.1002/hed.23840 · 3.01 Impact Factor
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    ABSTRACT: Background and objectives Late radiation-associated dysphagia (late-RAD) is a rare delayed toxicity, in oropharyngeal cancer (OPC) survivors. Prevention of late-RAD is paramount because the functional impairment can be profound and refractory to standard therapies. The objective of this analysis is to identify candidate dosimetric predictors of late-RAD and associated lower cranial neuropathies after radiotherapy (RT) or chemo-RT (CRT) for OPC. Materials and methods An unmatched retrospective case-control analysis was conducted. Late-RAD cases were identified among OPC patients treated with definitive RT or CRT. Controls were selected with minimum of 6 years without symptoms of late-RAD. Dysphagia-aspiration related structures (DARS) and regions of interest containing cranial nerve paths (RCCNPs) were retrospectively contoured. Dose volume histograms were calculated. Non-parametric bivariate associations were analyzed with Bonferroni correction and multiple logistic regression models were fit. Results Thirty-eight patients were included (12 late-RAD cases, 26 controls). Median latency to late-RAD was 5.8 years (range: 4.5–11.3 years). Lower cranial neuropathies were present in 10 of 12 late-RAD cases. Mean superior pharyngeal constrictor (SPC) dose was higher in cases relative to controls (median: 70.5 vs. 61.6 Gy). Mean SPC dose significantly predicted late-RAD (p = 0.036) and related cranial neuropathies (p = 0.019). RCCNPs did not significantly predict late-RAD or cranial neuropathies. Conclusions SPC dose may predict for late-RAD and related lower cranial neuropathies. These data, and those of previous studies that have associated SPC dose with classical dysphagia endpoints, suggest impetus to constrain dose to the SPCs when possible.
    Oral Oncology 06/2014; DOI:10.1016/j.oraloncology.2014.05.003 · 3.03 Impact Factor
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    ABSTRACT: Background We report the first clinical experience and toxicity of multifield optimization (MFO) intensity modulated proton therapy (IMPT) for patients with head and neck tumors. Methods and Materials Fifteen consecutive patients with head and neck cancer underwent MFO-IMPT with active scanning beam proton therapy. Patients with squamous cell carcinoma (SCC) had comprehensive treatment extending from the base of the skull to the clavicle. The doses for chemoradiation therapy and radiation therapy alone were 70 Gy and 66 Gy, respectively. The robustness of each treatment plan was also analyzed to evaluate sensitivity to uncertainties associated with variations in patient setup and the effect of uncertainties with proton beam range in patients. Proton beam energies during treatment ranged from 72.5 to 221.8 MeV. Spot sizes varied depending on the beam energy and depth of the target, and the scanning nozzle delivered the spot scanning treatment "spot by spot" and "layer by layer." Results Ten patients presented with SCC and 5 with adenoid cystic carcinoma. All 15 patients were able to complete treatment with MFO-IMPT, with no need for treatment breaks and no hospitalizations. There were no treatment-related deaths, and with a median follow-up time of 28 months (range, 20-35 months), the overall clinical complete response rate was 93.3% (95% confidence interval, 68.1%-99.8%). Xerostomia occurred in all 15 patients as follows: grade 1 in 10 patients, grade 2 in 4 patients, and grade 3 in 1 patient. Mucositis within the planning target volumes was seen during the treatment of all patients: grade 1 in 1 patient, grade 2 in 8 patients, and grade 3 in 6 patients. No patient experienced grade 2 or higher anterior oral mucositis. Conclusions To our knowledge, this is the first clinical report of MFO-IMPT for head and neck tumors. Early clinical outcomes are encouraging and warrant further investigation of proton therapy in prospective clinical trials.
    International journal of radiation oncology, biology, physics 05/2014; 89(4). DOI:10.1016/j.ijrobp.2014.04.019 · 4.18 Impact Factor
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    ABSTRACT: BACKGROUND: The purpose of this study was to evaluate long-term outcomes after induction chemotherapy followed by "risk-based" local therapy for locally-advanced squamous cell carcinoma of the head and neck (SCCHN). METHODS: Forty-seven patients (stage IV; ≥N2b) were enrolled in a phase II trial. Baseline and 24-month functional measures included modified barium swallow (MBS) studies, oropharyngeal swallow efficiency (OPSE), and the MD Anderson Dysphagia Inventory (MDADI). Functional status was assessed at 5 years. RESULTS: Five-year overall survival (OS) was 89% (95% confidence interval [CI], 81% to 99%). A nonsignificant 13% average reduction in swallowing efficiency (OPSE) was observed at 24 months relative to baseline (p = .191). MDADI scores approximated baseline at 24 months. Among 42 long-term survivors (median, 5.9 years), 3 patients (7.1%) had chronic dysphagia. The rate of final gastrostomy dependence was 4.8% (2 of 42). CONCLUSION: Sequential chemoradiotherapy achieved favorable outcomes among patients with locally advanced SCCHN, mainly of oropharyngeal origin. MBS and MDADI scores found modest swallowing deterioration at 2 years, and chronic aspiration was uncommon in long-term survivors. © 2013 Wiley Periodicals, Inc. Head Neck, 2013.
    Head & Neck 04/2014; 36(4). DOI:10.1002/hed.23330 · 3.01 Impact Factor
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    ABSTRACT: Summarize functional outcomes after transoral robotic surgery (TORS) ± adjuvant therapy for oropharyngeal cancer (OPC). A systematic review was conducted. The MEDLINE database was searched (MeSH terms: TORS, pharyngeal neoplasms, oropharyngeal neoplasms). Peer-reviewed human subject papers published through December 2013 were included. Exclusion criteria were as follows: (1) case report design (n < 10), (2) review article, or (3) technical, animal, or cadaver studies. Functional outcomes extracted included feeding tube dependence, swallow examination findings, speech ratings, velopharyngeal insufficiency, pneumonia, and oral intake measures. Twelve papers comprising 441 patients with OPC treated with TORS ± adjuvant therapy were included. Feeding tube rates were the most commonly reported functional outcome. Excluding prophylactic placement, 18-39 % of patients required gastrostomy placement, typically during adjuvant therapy. Chronic gastrostomy dependence ranged from 0 to 7 % (mean follow-up 11-26 months), regardless of disease stage. Composite MD Anderson Dysphagia Inventory (MDADI) scores ranged from 65.2 to 78 (89 patients, 3 series, mean follow-up 12-13 months). Videofluoroscopic swallowing studies were not systematically reported. Incidence of postoperative pneumonia was 0-7 %. Predictors of swallowing function included baseline function, T-stage, N-stage, tongue base primary tumors, and adjuvant chemoradiation. Rates of transient hypernasality were 4-9 %. A single study suggested dose-dependent effects of adjuvant therapy (none, radiation alone, chemoradiation) on diet scores at 6 and 12 months. Crude end points of functional recovery after TORS ± adjuvant therapy suggest promising swallowing outcomes, depending on the functional measure reported.
    Archives of Oto-Rhino-Laryngology 03/2014; 272(2). DOI:10.1007/s00405-014-2985-7 · 1.61 Impact Factor
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    ABSTRACT: To reduce the risk of long-term swallowing complications after radiation, swallowing exercises may be helpful. Both the rate of adherence to swallowing exercises and its impact on future swallowing function are unknown. In all, 109 patients with oropharyngeal cancer beginning radiation were tracked for 2 years to determine adherence to swallowing exercises. Participants completed the MD Anderson Dysphagia Inventory (MDADI) 1-2 years after treatment, to assess self-reported swallowing function. Adherence, demographics, tumor, and treatment variables were multivariably regressed onto the MDADI physical subscale score. In accord with speech pathologist documentation, 13% of the participants were fully adherent and 32% were partially adherent. Adherence was associated with the Physical MDADI Subscale score in the multivariate model (p = .01). The majority of patients with head and neck cancer are nonadherent to swallowing exercise regimens and may benefit from supportive care strategies to optimize their adherence. Head Neck, 2013.
    Head & Neck 12/2013; 35(12). DOI:10.1002/hed.23255 · 3.01 Impact Factor
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    ABSTRACT: BACKGROUND: Although many patients require nutritional support during radiotherapy or chemoradiotherapy for oropharyngeal cancer, little is known regarding the risk factors that predispose to gastrostomy tube (g-tube) placement and prolonged dependence, or the therapeutic interventions that may abrogate these effects. METHODS: We performed a retrospective medical chart review of patients who were treated for primary oropharyngeal cancer at a tertiary care center from 2003 to 2008. Patients who had a complete response at the primary site at 1-year posttreatment were included. G-tube placement and dependence ≥6 months were evaluated in relationship to site and stage of primary tumor, baseline characteristics, treatment type, smoking status, and swallowing intervention. RESULTS: We evaluated 474 patients (79%) with oropharyngeal cancer; 215 patients (40%) had concurrent chemotherapy, 73 patients (15%) had induction chemotherapy, and 69 patients (15%) had induction chemotherapy followed by concurrent chemotherapy. Two hundred ninety-three patients (62%) received g-tubes, of which 238 (81%) received the g-tube during radiation. At 1-year follow-up, 41 patients (9%) remained dependent on enteral feedings. Placement of g-tubes and prolonged g-tube dependence were significantly more likely in patients with T3 to 4 tumors (p < .001), baseline self-reported dysphagia (p < .001), odynophagia (p < .001), >10% baseline weight loss (p < .001), and in those treated with concurrent chemoradiotherapy. Patients who reported adherence to exercises had significantly lower rates of g-tube placement (p < .001), and duration of dependence was significantly shorter in those who reported adherence to swallowing exercises (p < .001). CONCLUSION: Almost 40% of patients with oropharyngeal cancer treated with nonsurgical organ preservation modalities may avoid feeding tube placement. Factors that predispose to g-tube placement and prolonged dependence include T3 to T4 tumors, concurrent chemotherapy, current smoking status, and baseline swallowing dysfunction or weight loss. Adherence to an aggressive swallowing regimen may reduce long-term dependence on enteral nutrition and limit the rate of g-tube placement overall. © 2013 Wiley Periodicals, Inc. Head Neck, 2013.
    Head & Neck 11/2013; 35(11). DOI:10.1002/hed.23200 · 3.01 Impact Factor
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    ABSTRACT: BACKGROUND: Placement of gastrostomy tubes (g-tubes) in patients with hypopharyngeal cancers undergoing radiation and chemotherapy is generally empirically determined. We examined our experience to identify predictive factors for g-tube placement and length of dependence. METHODS: We performed a retrospective review of all patients with primary hypopharyngeal cancer treated with nonsurgical modalities at a tertiary care center between 2002 and 2008. Rates of g-tube placement and length of dependence on enteral feedings were analyzed in relationship to multiple risk factors. RESULTS: Forty-three patients with hypopharyngeal primary tumors (77%) who had a complete response at the primary site after treatment were included. Thirteen patients (30%) never required g-tube placement. At 1-year follow-up, 11 patients (28%) maintained a g-tube. No clinical variables were significantly associated with g-tube placement. Duration of g-tube dependence was significantly longer in patients with a posterior hypopharyngeal wall primary tumors (p = .026), current smokers (p = .001), and patients with >40 pack-years (p = .010). The duration of g-tube dependence was significantly shorter in those who maintained oral intake at the end of treatment (p = .05), and those who reported adherence to dysphagia exercise regimens (p = .048). CONCLUSION: Approximately one third of patients with hypopharyngeal tumors treated on organ preservation regimens may be able to avoid g-tube placement, but further research is needed to identify clinical factors that predict g-tube placement in this population. A posterior hypopharyngeal wall primary and smoking history correlated with longer gastrostomy tube dependence. Adherence to aggressive targeted swallowing exercise regimens may help to prevent long-term dependence on feeding tubes. © 2013 Wiley Periodicals, Inc. Head Neck, 2013.
    Head & Neck 11/2013; 35(11). DOI:10.1002/hed.23199 · 3.01 Impact Factor
  • International Journal of Radiation OncologyBiologyPhysics 10/2013; 87(2):S604. DOI:10.1016/j.ijrobp.2013.06.1597 · 4.18 Impact Factor
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    ABSTRACT: Purpose/Objective(s) Late radiation-associated dysphagia (late-RAD) is a significant delayed toxicity in oropharyngeal cancer (OPC) survivors. Physiologic impairment of dysphagia-aspiration related structures (DARS) leads to post-swallow residue and aspiration. Prevention of this complication is paramount because the functional impairment can be profound, progressive, and refractory to standard therapies. The objective of this analysis was to identify candidate dosimetric predictors of late-RAD and lower cranial neuropathy after radiation therapy (RT) or chemo-RT (CRT) for OPC. Materials/Methods A retrospective case-control analysis was conducted. OPC patients treated with definitive RT/CRT 1999 through 2006 were included. Late-RAD was defined by new or progressive pharyngeal dysphagia per MBS > 4 years after RT/CRT. As a secondary endpoint, predictors of late lower cranial neuropathies (CN IX, X, XII) in late-RAD cases were examined. Controls were treated on an institutional trial and followed a minimum of 4 years without symptoms of late-RAD. DARS and regions of interest containing cranial nerve paths (RCCNPs) were retrospectively contoured. Dose volume histograms were calculated. Non-parametric bivariate associations were analyzed with Bonferroni correction and multiple logistic regression models were fit. Results Thirty-eight patients were included (12 late-RAD cases, 26 controls). Median latency to late-RAD was 5.8 years (range, 4.5-11.3 years). Lower cranial neuropathies were present in 10 late-RAD cases (IX = 4, X = 6, XII = 8), 7 of whom had multiple nerve palsies on physical examination. IMRT was delivered in all controls and 25% of cases (p < 0.001); the remainder received 3D RT. Smoking history, tumor subsite, fractionation schedule, neck dissection, and concurrent chemotherapy did not significantly differ between cases and controls (p > 0.05). T-stage was significantly higher in late-RAD cases (p = 0.002); N-stage was higher in controls (p = 0.109). Mean superior pharyngeal constrictor (SPC) dose was higher in cases relative to controls (median: 70.5 vs 61.6 Gy). Adjusting for T-stage, mean SPC dose significantly predicted late-RAD (p = 0.036) and cranial neuropathies (p = 0.019). RCCNPs did not significantly predict late-RAD or cranial neuropathies. Conclusions SPC dose may predict for late-RAD and related cranial neuropathies. These preliminary data, and those of previous studies that have associated SPC dose with earlier dysphagia outcomes, suggest impetus to constrain dose to the SPCs.
    ASTRO 2013, Atlanta; 10/2013
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    ABSTRACT: Importance Data support proactive swallowing therapy during radiotherapy (RT) or chemoradiotherapy (CRT) for pharyngeal cancers. The benefits of adherence to a regimen of swallowing exercises and maintaining oral intake throughout treatment are reported, but independent effects are unclear.Objective To evaluate the independent effects of maintaining oral intake throughout radiotherapy and adherence to preventive swallowing exercise.Design Retrospective observational study.Setting The University of Texas MD Anderson Cancer Center, Houston.Patients The study included 497 patients treated with definitive RT or CRT for pharyngeal cancer (458 oropharynx, 39 hypopharynx) between 2002 and 2008.Main Outcomes and Measures Swallowing-related end points were final diet after RT or CRT and duration of gastrostomy dependence. Primary independent variables included oral intake status at the end of RT or CRT (no oral intake, partial oral intake, or full oral intake) and adherence to a swallowing exercise regimen. Multiple linear regression and ordered logistic regression models were analyzed.Results At the conclusion of RT or CRT, 131 patients (26%) had no oral intake and 74% maintained oral intake (167 partial [34%], 199 full [40%]). Fifty-eight percent (286 of 497) reported adherence to swallowing exercises. Maintenance of oral intake during RT or CRT and swallowing exercise adherence were independently associated with better long-term diet after RT or CRT (P = .045 and P < .001, respectively) and shorter duration of gastrostomy dependence (P < .001 and P = .007, respectively) in models adjusted for tumor and treatment burden.Conclusions and Relevance The data indicate independent, positive associations of maintenance of oral intake throughout RT or CRT and swallowing exercise adherence with long-term swallowing outcomes. Patients who either eat or exercise fare better than those who do neither. Patients who both eat and exercise have the highest rate of return to a regular diet and shortest duration of gastrostomy dependence.
    09/2013; 139(11). DOI:10.1001/jamaoto.2013.4715
  • Katherine A Hutcheson · Jan S Lewin
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    ABSTRACT: The number of oral cavity and oropharyngeal cancer survivors is rising. By 2030, oropharyngeal cancers are projected to account for almost half of all head and neck cancers. Normal speech, swallowing, and respiration can be disrupted by adverse effects of tumor and cancer therapy. This review summarizes clinically distinct functional outcomes of patients with oral cavity and oropharyngeal cancers, methods of pretreatment functional assessments, strategies to reduce or prevent functional complications, and posttreatment rehabilitation considerations.
    Otolaryngologic Clinics of North America 08/2013; 46(4):657-70. DOI:10.1016/j.otc.2013.04.006 · 1.34 Impact Factor
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    ABSTRACT: BACKGROUND: Body image can be affected by bodily experiences extending beyond physical appearance. This study evaluated associations among speech, eating, and body image concerns for surgically treated patients with oral cavity, midface, and cutaneous cancers of the head and neck. METHODS: Using a cross-sectional design, 280 participants completed the Body Image Scale, a survey evaluating disease-specific body image issues, and the Functional Assessment of Cancer Therapy Scale-General. RESULTS: Participants with speech and eating concerns reported the highest levels of body image/appearance dissatisfaction compared with those without such concerns. This group also reported greater cognitive and behavioral difficulties associated with body image concerns and significantly higher levels of interest in psychosocial interventions to address appearance-related difficulties compared with all other participants. CONCLUSIONS: Findings point to the need for more comprehensive psychosocial care for patients with head and neck malignancies reporting speech and eating difficulties, which extent beyond functional rehabilitation. © 2012 Wiley Periodicals, Inc. Head Neck, 2012.
    Head & Neck 03/2013; 35(3). DOI:10.1002/hed.22980 · 3.01 Impact Factor
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    ABSTRACT: Changing trends in head and neck cancer (HNC) merit an understanding of the late effects of therapy, but few studies examine dysphagia beyond 2 years of treatment. A case series was examined to describe the pathophysiology and outcomes in dysphagic HNC survivors referred for modified barium swallow (MBS) studies ≥5 years after definitive radiotherapy or chemoradiotherapy (January 2001 through May 2011). Functional measures included the penetration-aspiration scale (PAS), performance status scale-head and neck (PSS-HN), National Institutes of Health Swallowing Safety Scale (NIH-SSS), and MBS impairment profile (MBSImp). Twenty-nine patients previously treated with radiotherapy (38%) or chemoradiotherapy (62%) were included (median years posttreatment, 9; range, 5-19). The majority (86%) had oropharyngeal cancer; 52% were never-smokers. Seventy-five percent had T2 or T3 tumors; 52% were N+. The median age at diagnosis was 55 (range, 38-72). Abnormal late examination findings included: dysarthria/dysphonia (76%), cranial neuropathy (48%), trismus (38%), and radionecrosis (10%). MBS studies confirmed pharyngeal residue and aspiration in all dysphagic cases owing to physiologic impairment (median PAS, 8; median NIH-SSS, 10; median MBSImp, 18), whereas stricture was confirmed endoscopically in 7 (24%). Twenty-five (86%) developed pneumonia, half requiring hospitalization. Swallow postures/strategies helped 69% of cases, but no patient achieved durable improvement across functional measures at last follow-up. Ultimately, 19 (66%) were gastrostomy-dependent. Although functional organ preservation is commonly achieved, severe dysphagia represents a challenging late effect that may develop or progress years after radiation-based therapy for HNC. These data suggest that novel approaches are needed to minimize and better address this complication that is commonly refractory to many standard dysphagia therapies. Cancer 2012. © 2012 American Cancer Society.
    Cancer 12/2012; 118(23):5793-9. DOI:10.1002/cncr.27631 · 4.90 Impact Factor
  • International Journal of Radiation OncologyBiologyPhysics 11/2012; 84(3):S63. DOI:10.1016/j.ijrobp.2012.07.270 · 4.18 Impact Factor

Publication Stats

2k Citations
470.22 Total Impact Points

Institutions

  • 2000–2015
    • University of Texas MD Anderson Cancer Center
      • Department of Head and Neck Surgery
      Houston, Texas, United States
  • 2009
    • Louisiana State University Health Sciences Center New Orleans
      • Department of Otolaryngology-Head and Neck Surgery
      Shreveport, LA, United States
  • 2001
    • University of Houston
      Houston, Texas, United States