title: Predictors of functional decline in locally advanced head and neck cancer patients from south Brazil.
abstract: BACKGROUND
  Functional decline in Brazilian patients with head and neck squamous cell carcinoma (HNSCC) is associated with impaired recovery, quality of life, and health care costs.
  
  
  METHODS
  Sixty patients enrolled at the regional oncology center in Curitiba, Brazil, were assessed over 6 months for toxicities, nutritional status, anthropometry, fatigue, stress, and functionality.
  
  
  RESULTS
  Severe mid-arm and mid-calf circumference depletion accompanied weight loss. Total fatigue score increased 64% (p < .001), as did perceived stress and serum cortisol (p = .01). Instrumental activities of daily living (IADL) dependence doubled, and activities of daily living (ADL) dependence quadrupled (p < .001). Difficulty chewing or swallowing, weight loss, fatigue, perceived stress, and IADL dependence accounted for 48.2% of ADL dependence.
  
  
  CONCLUSIONS
  The physical and psychological impact of HNSCC and its treatment are universally experienced; yet, screening and intervention for symptoms such as fatigue and stress are not typical clinical practice. Moreover, assessment of functional status is usually limited to chewing and swallowing. This study identified symptoms that require systematic intervention and randomized trials with functional independence as the outcome.
authors.affiliation: Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. heidi.j.silver@vanderbilt.edu
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Silver
authors.forename: Christine
authors.initials: C
authors.lastname: de Campos Graf Guimaraes
authors.forename: Paola
authors.initials: P
authors.lastname: Pedruzzi
authors.forename: Maraisa
authors.initials: M
authors.lastname: Badia
authors.forename: Adriana
authors.initials: A
authors.lastname: Spuldaro de Carvalho
authors.forename: Benedito V
authors.initials: BV
authors.lastname: Oliveira
authors.forename: Gyl H A
authors.initials: GH
authors.lastname: Ramos
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pietrobon
mesh_terms: D000203:Activities of Daily Living; D000222:Adaptation, Physiological; D000368:Aged; D001938:Brazil; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005221:Fatigue / Q000453:epidemiology; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D037981:Neck Dissection / Q000379:methods; D009752:Nutritional Status; D016522:Oncology Service, Hospital; D011183:Postoperative Complications / Q000503:physiopathology; D011237:Predictive Value of Tests; D011788:Quality of Life; D018570:Risk Assessment; D013315:Stress, Psychological; D013997:Time Factors; D015431:Weight Loss