Introduction
Materials and methods
Sample and setting
Procedures and assessments
Outcomes | Measurement instrument | Number of items |
---|---|---|
Patient-reported outcome | ||
Quality of life | ||
Generic | EuroQuol-5D (EQ-5D) | 6 |
Disease-specific | European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-core 30 (EORTC QLQ-C30) | 30 |
Tumor-specific | European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire module, Head and Neck 35 (EORTC QLQ-HN35) | 35 |
Speech | Speech Handicap Index (SHI) | 31 |
Swallowing | Swallowing QoL Questionnaire (SwalQoL) | 47 |
Shoulder | Shoulder Disability Questionnaire (SDQ) | 16 |
Hearing | Caron questionnaire on hearing | 19 |
Malnutrition | Short Nutritional Assessment Questionnaire (SNAQ) | 4 |
Cancer-related factors | ||
Comorbidity | Adult comorbidity evaluation (ACE-27) | 2 |
Personal factors | ||
Personality | Neuroticism-Extroversion-Openness-Five factor inventory (NEO-FFI) | 60 |
Locus of control | Pearlin and Schooler mastery scale (PSMS) | 5 |
Coping | Mental Adjustment to Cancer scale (MAC) | 39 |
Self-efficacy | Generalized self-efficacy scale (GES) | 10 |
Well-being | Posttraumatic Growth Inventory (PTGI) | 21 |
Physical appearance | Body Image Scale (BIS) | 10 |
Life events | Brugha Questionnaire | 13 |
Coping | Utrechtse Coping List (UCL) | 46 |
Psychobehavioral factors | ||
Severity anxiety/depression | Hospital Anxiety and Depression Scale (HADS) | 14 |
Fatigue | Multidimensional Fatigue Inventory (MFI) | 20 |
Fatigue | Fatigue Quality List (FQL) | 1 |
Sleep quality | Pittsburgh Sleep Quality Index (PSQI) | 15 |
Fear of recurrence | Cancer Worry Scale (CWS) | 8 |
Cognition | Cognitive Failure Questionnaire (CFQ) | 25 |
Physical factors | ||
Sexual function | ||
Males | International index of Erectile Function (IIEF) | 19 |
Females | Female Sexual Function Index (FSFI) | 15 |
Females | Study-specific questionnaire on fertility | 16 |
Lifestyle-related factors | ||
Alcohol intake | Study-specific questions | 13 |
Alcohol dependence | Study-specific questions | 7 |
Drug use | Study-specific questions | 7 |
Smoking | Study-specific questions | 8 |
Nicotine dependence | Study-specific questions | 5 |
Physical activity | Physical Activity Scale for the Elderly (PASE) | 31 |
Leisure | Study-specific questions | 15 |
Social factors | ||
Social support | Social Support List Interactions (SSL-I12) | 12 |
Participation | Impact on Participation and Autonomy (IPA) | 43 |
Health care use/costs | ||
Need and use care | Study-specific questionnaire | 28 |
Costs | Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness (TiC-P): Adapted version for HNC | 30 |
(Home) visit | ||
Personal factors | ||
Demographic | Standard questions | 23 |
Socioeconomic status/literacy | Standard questions | 27 |
Psychobehavioral factors | ||
Presence MDD | Composite international diagnostic interview (CIDI)—Major Depressive Disorder (MDD) | Variable |
Anxiety disorder | Composite international diagnostic interview (CIDI)—Anxiety disorders (GAD, SOC, PAN, AG) | Variable |
Pain | Brief Pain Inventory (BPI) | 13 |
Physical factors | ||
Speech quality | Speech recording (perceptual and objective analyses) | n.a. |
Pulmonary function | Peak flow | n.a. |
Strength—upper extremity | JAMAR handgrip dynamometer | n.a. |
Strength—lower extremity | 30s chair stand test | n.a. |
Cardiorespiratory fitness | Chester Step test | n.a. |
Body composition | Height, weight, body mass index, waist + hip circumference, thickness of four skin folds | n.a. |
Blood pressure | Systolic and diastolic blood pressure | n.a. |
Visual motor processing speed | Trail making test part A | n.a. |
Executive functioning | Trail making test part B | n.a. |
Activity monitoring | Accelerometer | n.a. |
Food | 24-h recall | n.a. |
Social factors | ||
Loneliness | De Jong-Gierveld Loneliness Scale | 11 |
Health care use/costs | ||
Work productivity | Productivity and disease questionnaire (PRODISQ) | 14 |
Biological and clinical factors | ||
Cancer-related factors | ||
Cancer location/stage | Standard questions, from medical record | n.a. |
Treatment modality | Standard questions, from medical record | n.a. |
Biological factors | ||
Tumor markers | Tumor tissue | n.a. |
Biomarkers | Blood | n.a. |
General laboratory | Blood | n.a. |
DNA | Blood | n.a. |
Proteomics | Blood | n.a. |
Gene expression (RNA) | Blood | n.a. |
Outcome measures
Representativeness was assessed by the following questions:
-
What percentage of eligible patients is willing to participate?
-
What are the main reasons for not participating?
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Are there differences between participants and non-participants regarding age, gender, diagnosis, comorbidity, stage, treatment, HRQoL, and emotional distress?
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A study-specific questionnaire consisting of four-point Likert scales (not feasible, a bit feasible, quit feasible, very much feasible) covering the number of items, time investment, intimacy and burden of the PROs, and the home visit.
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The number of items successfully completed was registered as well as the time needed to complete the PROs, as estimated by patients and the home visits as measured by a research physician.
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Is the protocol clear to other assessors (i.e., two experienced fieldworkers and a coordinator from the NESDA study)?
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Is the assessment protocol complete, clear, and accurate according to the research physician (A.N.)?
Statistical analysis
Results
Representativeness
Characteristics | Participants (n = 15) | Non-participants (n = 11) | Difference (p value) |
---|---|---|---|
Gender, n (%) male | 13 (87) | 4 (36) | 0.008 |
Age, mean ± SD (range) (years) | 63 ± 12 (40–80) | 62 ± 8 (52–78) | 0.926 |
Tumor location, n (%) | 0.986 | ||
Oral cavity | 4 (27) | 3 (27) | – |
Oropharynx | 5 (33) | 3 (27) | – |
Hypopharynx | 0 (0) | 0 (0) | – |
Larynx | 5 (33) | 4 (36) | – |
Unknown primary | 1 (7) | 1 (9) | – |
Disease stage, n (%) | 0.749 | ||
I | 2 (13) | 2 (18) | – |
II | 1 (7) | 1 (9) | – |
III | 5 (33) | 3 (27) | – |
IV | 7 (46) | 5 (45) | – |
Type of treatment, n (%) | 0.486 | ||
CHRT | 8 (53) | 4 (36) | – |
RT | 4 (27) | 2 (18) | – |
SURG | 1 (7) | 3 (27) | – |
TOE + SN | 2 (13) | 2 (18) | – |
Comorbidity, n (%) | |||
None | 4 (27) | 3 (27) | 0.683 |
Mild | 3 (20) | 3 (27) | – |
Moderate | 7 (47) | 3 (27) | – |
Severe | 1 (7) | 2 (18) | – |
Participant (n = 14) | Non-participant (n = 9) | ||
HADS | |||
Total score, mean ± SD | 10 ± 8 | 11 ± 5 | 0.587 |
Depression score ≥8, n (%) | 3 (21 %) | 1 (11 %) | 0.546 |
Anxiety score ≥8, n (%) | 3 (21 %) | 4 (44 %) | 0.262 |
Total score >15, n (%) | 3 (21 %) | 2 (22 %) | 0.966 |
EORTC QLQ-C30, mean ± SD | |||
Global quality of life | 78 ± 15 | 64 ± 29 | 0.145 |
Physical function | 87 ± 15 | 81 ± 23 | 0.480 |
Role function | 88 ± 24 | 74 ± 30 | 0.229 |
Emotional function | 60 ± 22 | 69 ± 20 | 0.296 |
Cognitive function | 88 ± 21 | 94 ± 8 | 0.402 |
Social function | 92 ± 18 | 85 ± 28 | 0.508 |
Achievability
Physical assessments | Percentage performed | Reasons for not performing physical assessments |
---|---|---|
Grip strength | 100 | – |
30-s chair stand test | 93 | Amputated leg (n = 1) |
Step test | 80 | Amputated leg (n = 1) Cardiac history (n = 1) Severe immobility (n = 1) |
Accelerometer | 53 | Amputated leg (n = 1) Severe immobility (n = 1) PEG tube placement (n = 2) Lost accelerometer (n = 2) Surgery, within a few days after visit (n = 1) |
Biological sample collection | Percentage performed | Reasons for not performing biological assessment |
Blood collection | 87 | Unwillingness (n = 2) |
Saliva collection | 87 | Not returned (n = 2) |
Tissue collection | 53 | Biopsy already taken (n = 1) No extra biopsies, direct surgery (n = 3) No extra biopsies, unknown primary tumor (n = 2) Reason not registered (n = 1) |
Not feasible | A bit feasible | Feasible | Very much feasible | |
---|---|---|---|---|
Questionnaires, n (%) | ||||
Number of items | – | – | 12 (86) | 2 (14) |
Time investment | – | – | 6 (40) | 8 (57) |
Personal or intimate character of questions | – | 1 (7) | 7 (50) | 6 (43) |
Home visits, n (%) | ||||
Number of questions | – | – | 3 (21) | 11 (79) |
Time investment | 1 (7) | – | 4 (29) | 9 (64) |
Personal or intimate character of questions | – | – | 2 (14) | 12 (86) |
Burden of physical assessments | – | – | 2 (14) | 12 (86) |