"My Voice"

Order a paperback or Kindle Edition or e-book of "My Voice: A Physician's Personal Experience with Throat Cancer," the complete 282 page story of Dr. Brook's diagnosis, treatment, and recovery from throat cancer.

Order a paperback or Kindle Edition or e-book of "The Laryngectomee Guide," the 170 page practical guide for laryngectomees.

Obtain and/or view a video presentation, a slide presentation and an instructive manual how to ventilate laryngectomees and neck breathers (free).

Thursday, August 22, 2019

Methods of speaking after laryngectomy



Allegra and colleagues from the  University of Catania, Catania, Italy compared the acoustic quality of the rehabilitated voice achieved with esophageal speech (ES) and tracheoesophageal speech (TES), and acoustic quality impacts on 67 laryngectomees.  The authors found a significantly better  functional voice performance in TES patients compared to ES.  However, there was no significant differences between the two groups in physical, emotional, and socioeconomic performance.

The authors concluded that the rehabilitation of laryngectomized patients must be addressed by a multidisciplinary team that considers the personalities, personal needs, and relational conditions of individual patients in order to determine and apply the phonatory rehabilitation method most suitable for achieving a better quality of life.




Thursday, June 20, 2019

Comparing surgical and nonsurgical larynx-preserving treatments with total laryngectomy for locally advanced laryngeal cancer.


Patel et al. from  Boston University School of Medicine, analyzed the National Cancer Data Base  between 2003 and 2011 (published in Cancer,June 2019) comparing surgical and nonsurgical larynx-preserving treatments with total laryngectomy for locally advanced laryngeal cancer.


They identified 8703 patients with stage III/IV (excluding T1 tumors) laryngeal squamous cell carcinoma treated with chemoradiation (CRT) or partial laryngectomy (PL) and total laryngectomy(TL)  with or without adjuvant therapy.

The authors found that:

  • Among patients with non-T4, low nodal burden (T2N1 or T3N0-N1) disease, no survival differences were observed between CRT, PL, and TL.
  • Patients who had non-T4, high nodal burden (T2-T3N2-N3) disease who underwent TL with or without adjuvant treatment had a higher risk of death compared with those who received CRT.
  • No statistically significant difference in outcome was noted between CRT and PL for all stage groups.   

The authors concluded that patients with non-T4, high nodal burden disease may benefit from definitive CRT. Total laryngectomy remains advantageous in patients with T4 disease.




Sunday, April 28, 2019

Head and Neck Squamous Cell Carcinona ( HNSCC) is more common and advanced in those living with Human Immunodeficiency Virus (HIV)


Several studies showed that patients living with HIV have a 3 fold higher risk of developing all types of HNSCC including those associated with HPV despite anti-retroviral therapy. This may be because HIV+ patients have a higher rate of alcohol rate and tobacco rate, increased incidence of oral HPV infection and immune suppression ( low CD4 count).

Findings of several studies illustrated that :

  • HPV infection is may be more prevalent in HIV+ patients.
  • The  HIV  virus may have a direct oncogenic role in HHNSCC.
  • HIV+ patients may present with HNSCC at a younger age and a higher stage.
  • Lower CD4 count may predispose patients to HPV related HNCSCC.
  • HIV + HNSCC+  have a poorer survival rates than HIV- HPV + .
  • HNSCC patients who are HPV+ tend to have a more favorable outcomes regardless of HIV status.


As the number of aging HIV+ patients increases learning more the pathophysiology of HNSCC in these patients, outcomes, and ultimately tailored treatment to these unique patient population will become more important.






Sunday, January 27, 2019

Use of nonsteroidal anti-inflammatory drugs improved patient survival for PIK3CA-altered head and neck cancer (HNC).


A new study by UC San Francisco and University of Pittsburgh has found that regular use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, significantly improves survival for a third or more patients with HNC. 

NSAIDs improved the overall 5-year survival rate from 25% to 78% for patients whose cancer contained a specific altered gene, known as PIK3CA. The survival for patients whose gene was not altered was unaffected by NSAID use.

PIK3CA is the most commonly altered oncogene in head and neck squamous carcinoma, and is found in a third of all tumors. In HNC associated with the human papillomavirus (HPV), PIK3CA is mutated in more than half of tumors.

The retrospective study included 266 patients. Most patients (67%) received post-surgery chemotherapy and/or radiotherapy. PIK3CA gene activating alteration was found in 28% in the patients. Among the patients who regularly used NSAIDs, 93% used aspirin (81mg/day) as a component of the NSAID regiment, and 73% took aspirin exclusively.
The investigators learned that regular use of NSAIDs for at least 6 months provided markedly prolonged improved survival compared to non-use for patients whose PIK3CAgene was mutated or amplified. In these patients, NSAIDs raised overall five-year survival from 25% to 78%. However, patients without alterations in their PIK3CA gene were no better off by taking NSAIDs.

This is the first study to show a strong clinical advantage of regular NSAID use for HNC patients with mutations in the PIK3CA gene and may indicate a clear, biological reason to implement NSAID therapy in certain cases of HNC patients
Through analysis of both cell line and mouse studies, the researchers speculated that NSAIDs likely blocked tumor growth by reducing the production of an inflammatory molecule called prostaglandin E2.

The researchers have designed a prospective, randomized clinical trial to address the study’s limitations (small numbers and retrospective nature of the study) to assess the clinical significance of this therapeutic use.





Saturday, September 1, 2018

Head and Neck Cancer: Through the Eyes of a Patient


Itzhak Brook, MD, MSc, and Meryl Kaufman, MEd, CCC-SLP, BRS-S, discuss cancers of the head and neck and talk about how diagnosis and treatment might impact patients and caregivers. To view click this (A Cure Today presentation.)

Episodes:

a.     An Overview of Head and Neck Cancer. Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, discuss the prevalence of cancers of the head and neck, emphasizing the potential risk factors and importance of prevention. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/an-overview-of-head-and-neck-cancer

b.     Head and Neck Cancer: Overcoming Challenges in Treatment. Itzhak Brook, M.D., M.Sc., shares the story of his initial diagnosis and treatment for cancer of the head and neck, outlining the challenges that came along with treatment, with fellow board member of the Head and Neck Cancer Alliance Meryl Kaufman, M.Ed., CCC-SLP, BRS-S. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/head-and-neck-cancer-overcoming-challenges-in-treatment


c.      Head and Neck Cancer: Novel Treatment Approaches. Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, share insight into the role of novel treatment approaches like immunotherapy, robotic surgery and de-escalation in the management of cancers of the head and neck. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/head-and-neck-cancer-novel-treatment-approaches


d.     Getting a Diagnosis of Head and Neck Cancer. Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, discuss which symptoms should lead one to seek a diagnosis of head and neck cancer and which tests are available to aid in evaluation. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/getting-a-diagnosis-of-head-and-neck-cancer

e.     Head and Neck Cancer from a Patient's Perspective.  Itzhak Brook, M.D., M.Sc., considers how experiencing cancer of the head and neck as a patient affected his understandings as a physician and outlines available patient resources with fellow board member of the Head and Neck Cancer Alliance, Meryl Kaufman, M.Ed., CCC-SLP, BRS-S. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/head-and-neck-cancer-from-a-patients-perspective


f.      Adjusting to Life With Head and Neck Cancer. Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, provide their perspectives on adjusting to life with cancer of the head and neck, as a patient or as a caregiver, and share advice for those who must undergo laryngectomy. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/adjusting-to-life-with-head-and-neck-cancer

g.     understanding Treatment Options in Head and Neck Cancer. Meryl Kaufman, M.Ed., CCC-SLP, BRS-S, and Itzhak Brook, M.D., M.Sc., board members of the Head and Neck Cancer Alliance, review the various modalities of treatment for cancers of the head and neck and identify which physicians are responsible for delivering this care. https://www.curetoday.com/cure-connections/hnscc/head-neck-cancers/understanding-treatment-options-in-head-and-neck-cancer




Meryl Kaufman, M.Ed., CCC-SLP,, and Itzhak Brook, M.D.

Wednesday, August 15, 2018

"The Laryngectomee Guide” is available in English, Spanish, Russian,Turkish, Italian, Bulgarian, Romanian, Arabic, Portuguese, French, Persian, Korean, Japanese, and traditional and simplified Chinese.

"The Laryngectomee Guide” is available now in the English, Russian,Turkish, Italian, Bulgarian, Romanian, Arabic, Spanish, Portuguese, French, Persian (Farsi), Korean, and traditional and simplified Chinese languages in both paperback and eBook forms.





Links to obtain the English language Guide are; paperback , Kindle, and eBook
Links to obtain the Russian language Guide are: paperback, and eBook
Links to obtain the Turkish language Guide are: paperback, and eBook.
Links to obtain the Italian language Guide are: paperback, and eBook.
Links to obtain the Bulgarian language Guide  are; paperback, and eBook.
Links to obtain the Romanian language Guide  are: paperback, and eBook 
Links to obtain the Arabic language Guide are: paperback, and  eBook.
Links to obtain the Spanish language Guide (Andine version): paperback, and Kindle.
Link to obtain the Spanish language Guide (Spain version) is: paperback, and  eBook.
Links to obtain the Spanish language Guide (Ct. Am. version) are paperback and Kindle.
Links the Spanish language Guide (S. America version) are: paperback and kindle
Links to obtain the Portuguese language Guide are: paperback, and eBook.
Link to obtain the French language Guide are: paperback, and eBook.
Links to obtain the Persian (Farsi) language Guide are: paperback, and eBook.
Links to obtain the Korean language Guide are: paperback, and eBook.
Links to obtain the Japanese language Guide are: paperback, and eBook.
Links to obtain the Traditional Chinese language Guide are: paperback, and eBook
Links to obtain the Simplified Chinese language Guide are: paperback, and eBook 

The Guide provides practical information that can assist laryngectomees and their caregivers with medical, dental and psychological issues. It contains information about side effects of radiation and chemotherapy; methods of speaking; airway, stoma, and voice prosthesis care; eating and swallowing; medical, dental and psychological concerns; respiration; anesthesia; and travelling.

To obtain a FREE eBook of the Guide in English click this link.
To obtain a FREE eBook of the Guide in Russian  click this link.
To obtain a FREE eBook of the Guide in Turkish click this link.  
To obtain a FREE eBook of the Guide in Italian click this link.
To obtain a FREE eBook of the Guide in Bulgarian click this link.
To obtain a FREE eBook of the Guide in Romanian click this link. 
To obtain a FREE eBook of the Guide in Arabic click this link.
To obtain a FREE eBook of the Guide in Spanish (Andine versionclick this link.
To obtain a FREE eBook of the Guide in Spanish (Spain version) click this link
To obtain a FREE eBook of the Guide in Spanish (Cent. Amer. version) click this link
To obtain a FREE eBook of the Guide in Spanish (S. America versionclick this link.
To obtain a FREE eBook of the Guide in Portuguese click this link.
To obtain a FREE eBook of the Guide in French click this link.
To obtain a FREE eBook of the Guide in Persian (Farsiclick this link.
To obtain a FREE eBook of the Guide in Korean click this link.
To obtain a FREE eBook of the Guide in Japanese click this link.
To obtain a FREE eBook of the Guide in traditional Chinese click this link
To obtain a FREE eBook of the Guide in simplified Chinese click this link.



                        Russian language Guide                       Turkish language Guide  




Italian language Guide                     Chinese language  Guide    
                                                                 
                                             



                                                                                      Bulgarian language guide                                Arabic language guide 








     Portuguese language Guide                               Persian language Guide
                


                                                       


       Romanian language Guide                                French language Guide




 

        Korean language Guide                             Spanish language Guide
                  

                                     

Tuesday, August 14, 2018

Positive initial margins is associated with poorer disease free survival (DFS) among patients with primary laryngeal squamous cell carcinoma who undergo total laryngectomy.



Positive initial margins, even among patients with negative final margins, appeared associated with poorer DFS among patients with primary laryngeal squamous cell carcinoma who received total laryngectomy, according to recently published findings. These were the findingof Tassone and colleagues of the Thomas Jefferson University.
The researchers performed a retrospective cohort study of 237 patients who underwent total laryngectomy for squamous cell carcinoma from February 2008 to July 2016. They considered margins positive if they contained invasive carcinoma, carcinoma in situ or severe dysplasia.

A total of 225 patients had negative final margins, and 127 underwent primary total laryngectomy, whereas 98 received salvage total laryngectomy. Salvage laryngectomy was associated with significantly worse, whereas primary total laryngectomy was not.

The authors concluded that surgical margin status may be an important prognostic factor in head and neck cancer. Furthermore, positive initial frozen margins even in patients with negative final margins, are associated with increased risk of local treatment failure in the context of primary total laryngectomy.


                                                         
                                                          Positive and negative tumor margins

Friday, July 27, 2018

Immunotherapy in head and neck squamous cell carcinoma

Head and neck squamous cell carcinoma is an immuno-suppressive malignancy, with many defects in the host immune system contributing to the progression of disease, as cancer cells evade immune-surveillance due to accumulation of genetic mutations and tumor heterogeneity. Improved understanding of the role of the immune system in cancer has led to the identification of novel therapeutic targets, and the development of a range of novel therapeutic targets which are being investigated for their potential to provide durable responses and improve the outcomes of this disease.

Immuno-oncology is an evolving field of investigation that includes active immunotherapies that are designed to target and harness the patient’s own immune system directly to fight cancer. More specifically, it is designed to leverage the unique properties of the immune system (specificity, adaptability, and memory).The primary goal of immunotherapy is to shift the balance in favor of an immune response against the tumor, allowing tumor eradication or long-term suppression of tumor growth, and the generation of immunological memory. Therapeutic approaches include: Monoclonal antibodies, Immune checkpoint inhibitors, Dendritic cells vaccines, and Adoptive T cell therapy.  The better understanding of the mechanisms of immune escape has led to the development of novel immunotherapies that has shown initial promising results in many solid tumors including Head and neck squamous cell carcinoma.




Saturday, December 16, 2017

Association of neurocognitive deficits with radiotherapy or chemoradiotherapy for patients with head and neck cancer


A study by Zer and colleagues of the University from Toronto General Hospital investigated the short- and long-term neurocognitive deficits (NCD) after treatment in patients with head and neck cancer (HNC). The investigators evaluated 80 newly diagnosed patients with head and neck cancer and 40 noncancer controls over a period of 2 years. Most patients had oropharyngeal SCC (76%); and received cisplatin-based chemoradiation (61%). The neurocognitive domains assessed were: intellectual capacity, concentration/short-term attention span, visual memory, verbal memory, processing speed, executive function, and motor dexterity.

The investigators found that neurocognitive function, although not immediately affected after treatment, progressively declines in 38% of the patients in the 2 years after definitive treatment with chemotherapy or radiation. A retrospective study by the same investigators suggested an association between radiation therapy for HNC and NCD and demonstrated an association of temporal lobe and cerebellum radiation dose with impaired memory and motor dexterity, respectively. Chemotherapy-induced NCD have been documented in other cancer populations (e.g., breast cancer and hematologic malignancy).

The authors recommend that adverse cognitive risks should be communicated to patients and families, and strategies to reduce toxic effects and cognitive rehabilitation options should be available for HNC survivors.



Tuesday, December 5, 2017

Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer: American Society of Clinical Oncology Clinical Practice Guideline 2017 Update


The American Society of Clinical Oncology has released new guideline recommendations for the use of larynx-preservation strategies in the treatment of laryngeal cancer, which was published in the Journal of Clinical Oncology.

A panel of expert confirmed that the use of a larynx-preservation approach for patients does not compromise survival. Furthermore, there was no larynx-preservation strategy found that offered a survival advantage compared with total laryngectomy and adjuvant therapy. Changes to the previous recommendations involved the use of endoscopic surgical resection in patients with T1 and T2 disease, initial total laryngectomy in patients with T4a disease, and PET imaging for evaluating regional nodes.

According to the new recommendations, patients with T1 or T2 laryngeal cancer should begin treatment with intent to preserve the larynx by using endoscopic resection or radiation therapy. As for patients with T2 or T4 disease, organ-preserving surgery in combination with chemotherapy and radiation (or radiation alone) may preserve the larynx without compromising overall survival. Selected patients with extensive T3 or large T4a lesions or poor laryngeal function prior to treatment are recommended total laryngectomy to achieve better survival rates and quality of life. 





Thursday, October 26, 2017

The books "My Voice- a physician's personal experience with throat cancer" and "The Laryngectomee Guide" are available in Turkish (Free).

I am happy to inform you that my  books "The Laryngectomee Guide”  and "My Voice- a physician's personal experience with throat cancer" are available now for FREE download. They were recently published by Turkish Association of Otorhinolaryngology- Head and Neck Surgery and are available on their site

The Laryngectomy Guide is available for FREE download in Turkish.







 "My Voice - a physician's personal experience with throat cancer is available for FREE download in Turkish




An Israeli physician helps improve the lives of head and neck cancer patients throughout the Middle East. Jerusalem Post October, 26, 2018.






Wednesday, September 20, 2017

Clinical Practice Guideline: Evaluation of the Neck Mass in Adults

The American Academy of Otolaryngology-Head and Neck Surgery Foundation has published the "Clinical Practice Guideline: Evaluation of the Neck Mass in Adults." These guidelines includes 12 recommendations how to reduce delays in diagnosis of head and neck squamous cell carcinoma; promote appropriate testing, including imaging, pathologic evaluation, and empiric medical therapies; reduce inappropriate testing; and promote appropriate physical examination when cancer is suspected.

The recommendations include these statements:

·        Clinicians should not routinely prescribe antibiotic therapy for patients with a neck mass unless there are signs and symptoms of bacterial infection.

·        Clinicians should identify patients with a neck mass who are at increased risk for malignancy when the patient lacks a history of infectious etiology and the mass has been present for 2 weeks without significant fluctuation, or the mass is of uncertain duration.
·
·        Clinicians should identify patients with a neck mass who are at increased risk for malignancy based on 1 of these physical examination characteristics: fixation to adjacent tissues, firm consistency, size .1.5 cm, and/or ulceration of overlying skin.
·
·        Clinicians should conduct an initial history and physical examination for all adults with a neck mass to identify those patients with an increased risk for malignancy.

·        For patients with a neck mass who are not at increased risk for malignancy, clinicians or their designees should advise patients of criteria that would trigger the need for additional evaluation. Clinicians or their designees should also document a plan for follow-up to assess resolution or final diagnosis.

·        For patients with a neck mass who are deemed at increased risk for malignancy, clinicians or their designees should explain to the patient the significance of being at increased risk and explain any recommended diagnostic tests.

·        Clinicians should perform, or refer the patient to a clinician who can perform, a targeted physical examination (including visualizing the mucosa of the larynx, base of tongue, and pharynx) for patients with a neck mass deemed at increased risk for malignancy.

·        Clinicians should order neck computed tomography (CT; or magnetic resonance imaging [MRI]) with contrast for patients with a neck mass deemed at increased risk for malignancy.

·        Clinicians should perform fine needle aspiration (FNA) instead of open biopsy, or refer the patient to someone who can perform FNA, for patients with a neck mass deemed at increased risk for malignancy when the diagnosis of the neck mass remains uncertain.

·        For patients with a neck mass deemed at increased risk for malignancy, clinicians should continue evaluation and perform additional ancillary tests of patients with a cystic neck mass, as determined by FNA or imaging studies, until a diagnosis is obtained and should not assume that the mass is benign.

Hopefully this guideline will promote the efficient, effective, and accurate diagnostic workup of neck masses to ensure that adults with potentially malignant disease receive prompt diagnosis and intervention to optimize outcomes.


Click here to read the executive summary of the guidelines, click here to read the guidelines and click here to read the plain language summary. 


  

Wednesday, August 23, 2017

Current laryngectomy-related patient education materials are too difficult for an average adult to understand

A recent study by Wong and colleagues from the Boston University Medical Center found that current laryngectomy-related patient education materials are too difficult for an average American adult to understand.

The authors evaluated laryngectomy-related educational materials from an online search using the validated Patient Education Materials Assessment Tool, calculated reading difficulty, and assessed the correlation between readability, understand-ability, and action ability.

The authors concluded that current laryngectomy-related patient education materials are highly variable in understandability and action ability, and reading difficulty across all formulas also exceeded the eighth-grade reading level of an average American adult.They suggested that future revisions of laryngectomy-related educational materials may be warranted in order for current materials to benefit a wider readership.