Abril - 2017

ungerman

314

ssoc

ras

2017; 63(4):311-319

of flavor), feeding tube, fear of adverse events and strate-

gies to cope with the illness and treatment, specialist care

at home, physical activity and too much salivation.

In the pretest survey, among the specialists listed in

the original PCI version, dental hygienist and chaplain

were not easily identified by patients, as well as emotional

support therapists (a clinical specialty just below the level

of a psychologist that exists in the United Kingdom, but

not in Brazil). For the final consensus version, the spe-

cialty dental hygienist was removed, chaplain was replaced

by the religious authority/leader of their religion, and

psychologist and psychiatrist were added.

Cultural validation study

A consecutive series of 84 patients with UADT cancers were

enrolled between February 2013 and June 2013 for this

study, and they completed the final Brazilian Portuguese

version of the PCI and the Brazilian Portuguese version of

the UW-QOLv4. Most patients were male (74%), mean age

of 62 years (ranging from 36 to 89 years), with low educa-

tion level (57%) and histologically confirmed squamous

cell carcinoma (SCC) (89%). Tumor sites were the oral cav-

ity in 35 patients (42%), larynx in 20 patients (24%), oro-

pharynx in 19 patients (23%), nasopharynx in three patients

(4%), hypopharynx in three patients (4%), nasal and para-

nasal sinuses in two patients (2%), and occult primary tu-

mors in two patients (2%). Most of them presented with

tumors at an advanced stage: T3 in 19 patients (23%) and

T4 in 25 (30%). Half of the patient sample was clinically

negative for lymph node involvement (50%), and almost all

patients were clinically negative for distant metastasis (96%).

Regarding time interval between treatment and question-

naire completion, 25 patients (30%) marked less than 12

months, 22 patients (26%) between 12 and 36 months and

37 patients (44%) for 36 months or more. Thirty-four (34)

patients (40%) underwent surgery and radiotherapy, 29

(35%) underwent primary radiotherapy and 21 (25%) under-

went surgery only. Thirty-five (35) patients (42%) underwent

chemotherapy at some point during their treatment.

The time required to fill out the PCI ranged from 6

to 20 minutes (mean: 13 minutes). The frequency of the

items indicated on the PCI is described in Figures 1 and

2. Among the items listed in the inventory, issues selected

most frequently by patients for discussion included the

following: fear of cancer returning (57%), dry mouth (45%),

chewing/eating (44%), speech/voice/being understood

(43%), swallowing (40%), dental health/teeth (36%), anxi-

ety (31%), fatigue/tiredness (30%), taste (sense of flavor)

(30%) and fear of adverse events (30%) (Figure 1). The

three specialists most selected by patients were speech

therapist by 22 patients (26%), dentist by 20 patients (24%)

and psychologist by 15 patients (18%) (Figure 2). The

median (interquartile range – IQR) number of PCI items

selected was eight (5-13), ranging between 0 and 42 items,

with 75 patients (89%) selecting at least one item. The

median (IQR) number of specialists indicated was one

(0-2), ranging between zero and eight specialists, with 30

patients (36%) selecting at least one specialist.

The number of concerns and specialists selected cor-

related weakly with the time of diagnosis (-0.29, p=0.007

and -0.28, p=0.01), with more items selected in the case

of shorter interval between the end of treatment and

participation in the study, while patient age correlated

with the number of specialists selected (-0.28, p=0.009)

in that younger patients selected a greater number of

specialists (Table 1). There were no other significant as-

sociation of clinical variables studied with the number of

items and specialists selected.

The mean composite score for UW-QOL was 73 (stan-

dard deviation [SD], 20). For the physical and socio-emo-

tional domains, the scores were respectively, 78 (21) and

67 (24). The physical and socio-emotional domains of the

UW-QOL were significantly correlated with the number

of concerns selected (-0.46 and -0.45, both p<0.001) and

with the number of specialists selected (-0.46, p<0.001

and -0.33, p=0.002). The worse the UW-QOL score, the

more PCI items were selected.

Significant associations between specific issues and

specialists selected with patient characteristics and with

the physical and socio-emotional domains of the UW-QOL

were detected. Patients under 55 years of age selected more

items of dental health (50%) and fear of cancer returning

(75%) than older patients. Females were more than twice

as likely as males to select sleep and anxiety, with 8/22

(36%) and 12/22 (55%), respectively. Patients with post-

treatment interval of 12 months or less selected consider-

ably more items than patients with longer than 12 months

treatment interval regarding to appetite (40%), cancer

treatment (48%), use of a feeding tube (32%), wound heal-

ing (16%) support for the family (16%), and specialist

dietician (28%) and speech therapist (52%). Appetite (42%)

and appearance (46%) were about three times more like-

ly to be selected by patients who had more extensive neck

disease (N2-N3). Individuals undergoing reconstruction

indicated excessive salivation (22%) more frequently than

those without reconstruction (3%). The item dry mouth

was indicated by 16 (35%) patients who underwent radio-

therapy and 17 (81%) who did not undergo surgery. In

addition, 19 patients (66%) who underwent primary ra-

diotherapy (RT) selected dry mouth, and one-third of