Predictors of functional decline in locally advanced head and neck cancer patients from south Brazil.
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.
Silver
Heidi J
HJ
Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. heidi.j.silver@vanderbilt.edu
de Campos Graf Guimaraes
Christine
C
Pedruzzi
Paola
P
Badia
Maraisa
M
Spuldaro de Carvalho
Adriana
A
Oliveira
Benedito V
BV
Ramos
Gyl H A
GH
Dietrich
Mary S
MS
Pietrobon
Ricardo
R
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