- Email: [email protected]
Outcome of head and neck cancer patients in palliative care
1282
21st ICOMS 2013—Abstracts: Oral Papers
T18.OR033 Outcome of head and neck cancer patients in palliative care S. Siddiqui 1,∗ , M. Zolotar 2,3 , C. Schilling 2,3 , V. Pace 2,3 , M. McGurk 2,3 1
Kings College London, United Kingdom Guys and St Thomas NHS Trust, United Kingdom 3 St Christophers Hospice, United Kingdom 2
Introduction: In the UK 5000–7000 head and neck cancer cases are diagnosed annually. Only 50 per cent are curable. The remaining terminal cases are managed by palliative care services in the community and in hospices. Our study aimed to identify the outcome of patients once referred onwards from secondary care. We performed a retrospective analysis of patients referred to St Christopher’s Hospice in London. Method: Over a 3-year period 94 patients were referred to St Christopher’s Hospice and its associate Harris Hospice, from Guy’s, St George’s and the Royal Marsden Hospitals. We collected information regarding the age and gender of patients alongside time of referral, type and location of their cancer, previous treatment, functional problems with activities of daily life, psychosocial difficulties, pain control, place and circumstances of death. Results: From January 2010 to December 2012, 61 male and 33 female patients were referred to St Christopher’s. At referral their ages ranged from 30 to 102 years. The predominant locations of tumours were base of tongue (15), tonsil (13) and nasopharynx (12). Of these cases, 5 deaths occurred in hospital, 18 at home, 4 in care homes and 45 in a hospice at time of review. Conclusion: This study identifies outcomes of patients when they leave head and neck cancer services and highlights areas where liaison between palliative care and head and neck services may improve patient care during this stage of their disease. http://dx.doi.org/10.1016/j.ijom.2013.07.369 T18.OR034 Discrepancy between clinical and pathological staging of head and neck cancer – ‘the stage migration’ A. Siddiqui 1,∗ , T. Lowe 2 1
NHS Grampian – Aberdeen Royal Infirmary Consultant Oral Maxillofacial Surgeon, Maxillofacial Unit – NHS Grampian
2
Rationale: The TNM system for classification of Head and neck malignant tumours is a universally accepted, widely used, staging method which helps clinicians and researchers to choose from treatment options, and gives patients an estimate of their prognosis. However the clinical and histopathological staging of some patients may differ (stage migration) leading to significant effect on prognosis and treatment type. Patients and methods: We compared clinical and pathologic TNM staging in a large and contemporary series of 86 head and neck cancer patients who were treated with head and neck surgery with or without adjuvant radiotherapy and/or chemotherapy. Results: In more than half of the patients in the cohort, the clinical and pathological tumour sizes did not co-relate (table below). A complete description of the results and explanation of possible causes will be presented in the meeting. Same clinical and pathological tumour size 39 (44.3%) clinical staging higher than
pathological staging 27 (30.7%) pathological staging higher than clinical staging 16 (18.2%) could Not be determined 6 (6.8%). Conclusion: Major discrepancy was found between clinical and pathological staging in our cohort. We propose a further prospective study to measure the accuracy of clinical and histopathological staging in head and neck cancer. http://dx.doi.org/10.1016/j.ijom.2013.07.370 T18.OR035 A new treatment option for lichen planus – a pilot study V. Singh 1,∗ , M. Pal 2 1 2
K.G. Medical University, India National Botinical Research Institute, India
Lichen planus is a relatively common disorder, estimated to effect 0.5–2.0% of the general population. It is a chronic inflammatory disease affecting mucosal and cutanous tissue. Various treatment regimens have been designed to improve management of symptomatic oral lichen planus but permanent cure is not yet possible. The extract of curcumin plant have been a major ingredient of medicine since the time immemorial. It has been attributed a number of medicinal properties in the traditional systems of the medicine. Turmeric and its ingredients, curcumin are being studied as chemo preventive agent that inhibits the development of oral cancer, curcumin and essential oil of turmeric have been found to inhibit many diseases processes through their ant inflammatory, antioxidant and anticancer properties. Hence this was under taken to investigate the role of curcumin longa as an alternative means of treatment of the oral lichen planus. An immunosuppressive agent affects the severity and progression of oral LP but theatrically they could al so trigger malignant transformation. Material and methods: A pilot study was conducted in the Department of Oral and Mxillofacial surgery. The 10 patients were included in the study, they were clinically diagnosed and histipathologically confirmed as patients of oral lichen planus. The extract of turmeric in the ointment form was made at NBRI, used for local application twice/day for a period of 3 months. The patients were instructed to report after every 15th day for check up and to collect the ointment. Results: The severity of the clinical sign and symptoms were entered in the set proforma. The data was collected tabulated and analyzed. Significant improvement was observed in the clinical symptoms of the patients. Above all it was well tolerated no adverse reaction was observed. http://dx.doi.org/10.1016/j.ijom.2013.07.371 T18.OR036 Gemcitabine induces phenotypic alterations of tumor cells that facilitate antitumor T cell responses in a mouse model of oral cancer K. Tomihara ∗ , N. Arai, M. Noguchi Department of Oral and Maxillofacial Surgery, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, Japan Background and objectives: Gemcitabine (GEM) is a pyrimidine nucleoside analogue that is a new chemotherapeutic agent used for treating various cancers. Because accumulating evidence indicates that GEM may activate host immune responses, its
21st ICOMS 2013—Abstracts: Oral Papers
T18.OR033 Outcome of head and neck cancer patients in palliative care S. Siddiqui 1,∗ , M. Zolotar 2,3 , C. Schilling 2,3 , V. Pace 2,3 , M. McGurk 2,3 1
Kings College London, United Kingdom Guys and St Thomas NHS Trust, United Kingdom 3 St Christophers Hospice, United Kingdom 2
Introduction: In the UK 5000–7000 head and neck cancer cases are diagnosed annually. Only 50 per cent are curable. The remaining terminal cases are managed by palliative care services in the community and in hospices. Our study aimed to identify the outcome of patients once referred onwards from secondary care. We performed a retrospective analysis of patients referred to St Christopher’s Hospice in London. Method: Over a 3-year period 94 patients were referred to St Christopher’s Hospice and its associate Harris Hospice, from Guy’s, St George’s and the Royal Marsden Hospitals. We collected information regarding the age and gender of patients alongside time of referral, type and location of their cancer, previous treatment, functional problems with activities of daily life, psychosocial difficulties, pain control, place and circumstances of death. Results: From January 2010 to December 2012, 61 male and 33 female patients were referred to St Christopher’s. At referral their ages ranged from 30 to 102 years. The predominant locations of tumours were base of tongue (15), tonsil (13) and nasopharynx (12). Of these cases, 5 deaths occurred in hospital, 18 at home, 4 in care homes and 45 in a hospice at time of review. Conclusion: This study identifies outcomes of patients when they leave head and neck cancer services and highlights areas where liaison between palliative care and head and neck services may improve patient care during this stage of their disease. http://dx.doi.org/10.1016/j.ijom.2013.07.369 T18.OR034 Discrepancy between clinical and pathological staging of head and neck cancer – ‘the stage migration’ A. Siddiqui 1,∗ , T. Lowe 2 1
NHS Grampian – Aberdeen Royal Infirmary Consultant Oral Maxillofacial Surgeon, Maxillofacial Unit – NHS Grampian
2
Rationale: The TNM system for classification of Head and neck malignant tumours is a universally accepted, widely used, staging method which helps clinicians and researchers to choose from treatment options, and gives patients an estimate of their prognosis. However the clinical and histopathological staging of some patients may differ (stage migration) leading to significant effect on prognosis and treatment type. Patients and methods: We compared clinical and pathologic TNM staging in a large and contemporary series of 86 head and neck cancer patients who were treated with head and neck surgery with or without adjuvant radiotherapy and/or chemotherapy. Results: In more than half of the patients in the cohort, the clinical and pathological tumour sizes did not co-relate (table below). A complete description of the results and explanation of possible causes will be presented in the meeting. Same clinical and pathological tumour size 39 (44.3%) clinical staging higher than
pathological staging 27 (30.7%) pathological staging higher than clinical staging 16 (18.2%) could Not be determined 6 (6.8%). Conclusion: Major discrepancy was found between clinical and pathological staging in our cohort. We propose a further prospective study to measure the accuracy of clinical and histopathological staging in head and neck cancer. http://dx.doi.org/10.1016/j.ijom.2013.07.370 T18.OR035 A new treatment option for lichen planus – a pilot study V. Singh 1,∗ , M. Pal 2 1 2
K.G. Medical University, India National Botinical Research Institute, India
Lichen planus is a relatively common disorder, estimated to effect 0.5–2.0% of the general population. It is a chronic inflammatory disease affecting mucosal and cutanous tissue. Various treatment regimens have been designed to improve management of symptomatic oral lichen planus but permanent cure is not yet possible. The extract of curcumin plant have been a major ingredient of medicine since the time immemorial. It has been attributed a number of medicinal properties in the traditional systems of the medicine. Turmeric and its ingredients, curcumin are being studied as chemo preventive agent that inhibits the development of oral cancer, curcumin and essential oil of turmeric have been found to inhibit many diseases processes through their ant inflammatory, antioxidant and anticancer properties. Hence this was under taken to investigate the role of curcumin longa as an alternative means of treatment of the oral lichen planus. An immunosuppressive agent affects the severity and progression of oral LP but theatrically they could al so trigger malignant transformation. Material and methods: A pilot study was conducted in the Department of Oral and Mxillofacial surgery. The 10 patients were included in the study, they were clinically diagnosed and histipathologically confirmed as patients of oral lichen planus. The extract of turmeric in the ointment form was made at NBRI, used for local application twice/day for a period of 3 months. The patients were instructed to report after every 15th day for check up and to collect the ointment. Results: The severity of the clinical sign and symptoms were entered in the set proforma. The data was collected tabulated and analyzed. Significant improvement was observed in the clinical symptoms of the patients. Above all it was well tolerated no adverse reaction was observed. http://dx.doi.org/10.1016/j.ijom.2013.07.371 T18.OR036 Gemcitabine induces phenotypic alterations of tumor cells that facilitate antitumor T cell responses in a mouse model of oral cancer K. Tomihara ∗ , N. Arai, M. Noguchi Department of Oral and Maxillofacial Surgery, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, Japan Background and objectives: Gemcitabine (GEM) is a pyrimidine nucleoside analogue that is a new chemotherapeutic agent used for treating various cancers. Because accumulating evidence indicates that GEM may activate host immune responses, its