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Friday, January 10, 2014

Importance of patient reporting new symptoms in the early detection of head and neck cancer recurrence

A recent study by Nisa and colleagues from Sion, Switzerland, evaluated the value of patients' reported symptoms as an indicator of tumor recurrence after definitive treatment for head and neck squamous cell carcinoma. Cancer recurrence occurred in 30 of the 101 patients included in the study had local and/or regional recurrences.

One-third of all patients had early stage, and two-thirds had advanced-stage tumors; two-thirds received only single treatment modality (i.e., surgery, radiation) and one-third had multiple treatment modalities. Most patients were male, with a mean age of 61.5 years (range, 29-85 years), and had at least one risk factor (tobacco and alcohol).

New-onset symptoms had the best correlation with cancer recurrences. Localized pain, pain on swallowing (odynophagia), and impaired ability to produce voice (dysphonia) were independently correlated with recurrences. Correlation was better between 6 to 12 and 18 to 21 months after therapy and in patients initially treated with only one type of therapy (i.e., surgery or radiation alone).  Primary stage and tumor site had no effect on the correlation.

The study underlines the importance of close and continuous follow-up after treatment of head and neck cancer especially during the first 2 years. It also illustrates that patient input and vigilance in reporting new symptoms are instrumental in diagnosing cancer recurrence. Close follow-up has other important goals, especially the identification and management of treatment-related complications and psycho-social support.