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Quality of end of life care in head and neck cancer in England 2003–2012
e162
Oral Presentation
P.J. Voss ∗ , P. Poxleitner, K. Nelson, R. Schmelzeisen, A. Spanou
of death, postcode of place of residence, date of birth, sex and cause of death) were obtained from Office for National Statistics (ONS) mortality files derived from death certificates (2003-2012). Deprivation figures are based on indices of deprivation 2010 (ID 2010) income deprivation scores aggregated from Lower Super Output Areas (LSOAs). Findings: An analysis of 27,257 deaths from head and neck cancer in England from 2003 to 2012 reveals the relative young age and high levels of deprivation at death of patients with head and neck cancer, particular amongst males. There is a significant geographical variation in proportion of patients dying in hospital, over above the relationship between deprivation and death in hospital. Conclusions: We highlight the potential high level of need for patients dying from head and neck cancers because of their young age and high levels of deprivation. We also show how tumour site, age, gender, socioeconomic deprivation and geographical area of residence impacts on place of death.
Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Germany
http://dx.doi.org/10.1016/j.ijom.2015.08.859
A total of 32 patients have participated in this ongoing clinical trial. 30 patients have completed the study. 66% of the study participants were females and the mean age of study participants was 22.4 ± 5.1. Majority of the patients (80%) did not develop pain for 1.5 h following surgery. Average pain levels in the Ibuprofen group were lower than pain in the Acetaminophen group. The number of narcotic medications was lower in the Ibuprofen group as well. Both medications were tolerated well without any adverse effects. This is an ongoing clinical study and further analysis is required to find out if the results are statistically significant. http://dx.doi.org/10.1016/j.ijom.2015.08.857 Healing of extraction sites in patients under bisphosphonate: a clinical cohort study
Background: Bisphosphonate-associated necrosis of the jaws (BP-ONJ) has become a major clinical challenge and tooth extraction is considered to be a major risk factor for its development. Objectives: The purpose of this study is the clinical evaluation of patients under bisphosphonate therapy who received a single or multiple tooth extractions using a specific treatment protocol and surgical technique. Methods: Eighty-four patients, who were currently under bisphosphonate therapy, underwent 232 tooth extractions with primary wound closure. The extraction sites were evaluated over a mean follow-up period of 16.6 months and the occurrence of BP-ONJ was documented. Findings: Two of the eighty-four patients developed osteonecrosis of the jaws. This results in an incidence of 2.4%. Both of the patients with ONJ received radiation therapy in the head and neck area after the tooth extraction. The remaining eighty-two patients had uneventful healing and did not present any signs or symptoms of BP-ONJ during the follow-up period. Conclusions: The wide use of bisphosphonates and the fact that tooth extraction is one of the most common dental procedures can explain why numerous patients necessitate tooth extractions while on bisphosphonate therapy. We suggest a specific and effective treatment protocol and believe that tooth extraction in this group of patients does not constitute a contraindication, for it can be uneventfully and successfully performed. http://dx.doi.org/10.1016/j.ijom.2015.08.858 Quality of end of life care in head and neck cancer in England 2003–2012 T. Walker 1,∗ , S. Thomas 1 , J. Verne 2 1 2
University of Bristol, Bristol, UK Public Health England, Bristol, UK
Background: Place of death can be used as a proxy marker for patient perceived quality of end of life care. Head and neck cancers can lead to difficult issues around the end of life. By examining the factors that influence place of death in head and neck cancer patients, we can begin to understand the issues affecting those who are dying, and help to plan appropriate services for them. Methods: Incidence data is collected from UK Cancer Information Service (CIS). Key data items used for this analysis (place
Mission tracker the first six months: web based solutions to integration of horizontal and vertical cleft care in the developing world T. Walker 1,∗ , P. Coles 2 , P. Ayliffe 3 , C. Mills 3 1
University of Bristol, Bristol, UK Accenture, London, UK 3 Great Ormond Street Hospital, London, UK 2
Background: Humanitarian cleft missions fill a temporal gap in local service provision in the developing world. This can be variable in terms of frequency and geography. The vertical nature of these can prevent the development of horizontally integrated locally sustainable clinical networks for the management of children with clefts. Many children receive excellent surgical treatment, however there is marked inequity and inequality between the services provided to children in the developing and developed world. We present a tech solution that will lead to the development of specialist treatment centres in the developing world that are sustainable, and will allow full horizontal integration and support to local service providers. Methods: A web portal would allow verified registration of cleft surgical missions in terms of location, dates, contact details and biographies of team members. Interactive map and calendaring as well as search facility would be available. Basic social networking functionality would allow contact between groups, as well as discussion fora and file sharing. Results: We will take this opportunity to present the results of the first six months of Mission Tracker, the issues that we have come across and over come since its launch in April 2015. Conclusions: Global cleft mission co ordination will allow, country by country, the development of specialist cleft centers that can host missions and provide a home for the charity funded multi disciplinary team and give children in the developed world the appropriate multi disciplinary treatment that vertical humanitarian mission cannot provide. http://dx.doi.org/10.1016/j.ijom.2015.08.860
Oral Presentation
P.J. Voss ∗ , P. Poxleitner, K. Nelson, R. Schmelzeisen, A. Spanou
of death, postcode of place of residence, date of birth, sex and cause of death) were obtained from Office for National Statistics (ONS) mortality files derived from death certificates (2003-2012). Deprivation figures are based on indices of deprivation 2010 (ID 2010) income deprivation scores aggregated from Lower Super Output Areas (LSOAs). Findings: An analysis of 27,257 deaths from head and neck cancer in England from 2003 to 2012 reveals the relative young age and high levels of deprivation at death of patients with head and neck cancer, particular amongst males. There is a significant geographical variation in proportion of patients dying in hospital, over above the relationship between deprivation and death in hospital. Conclusions: We highlight the potential high level of need for patients dying from head and neck cancers because of their young age and high levels of deprivation. We also show how tumour site, age, gender, socioeconomic deprivation and geographical area of residence impacts on place of death.
Department of Oral and Maxillofacial Surgery, University Medical Center Freiburg, Germany
http://dx.doi.org/10.1016/j.ijom.2015.08.859
A total of 32 patients have participated in this ongoing clinical trial. 30 patients have completed the study. 66% of the study participants were females and the mean age of study participants was 22.4 ± 5.1. Majority of the patients (80%) did not develop pain for 1.5 h following surgery. Average pain levels in the Ibuprofen group were lower than pain in the Acetaminophen group. The number of narcotic medications was lower in the Ibuprofen group as well. Both medications were tolerated well without any adverse effects. This is an ongoing clinical study and further analysis is required to find out if the results are statistically significant. http://dx.doi.org/10.1016/j.ijom.2015.08.857 Healing of extraction sites in patients under bisphosphonate: a clinical cohort study
Background: Bisphosphonate-associated necrosis of the jaws (BP-ONJ) has become a major clinical challenge and tooth extraction is considered to be a major risk factor for its development. Objectives: The purpose of this study is the clinical evaluation of patients under bisphosphonate therapy who received a single or multiple tooth extractions using a specific treatment protocol and surgical technique. Methods: Eighty-four patients, who were currently under bisphosphonate therapy, underwent 232 tooth extractions with primary wound closure. The extraction sites were evaluated over a mean follow-up period of 16.6 months and the occurrence of BP-ONJ was documented. Findings: Two of the eighty-four patients developed osteonecrosis of the jaws. This results in an incidence of 2.4%. Both of the patients with ONJ received radiation therapy in the head and neck area after the tooth extraction. The remaining eighty-two patients had uneventful healing and did not present any signs or symptoms of BP-ONJ during the follow-up period. Conclusions: The wide use of bisphosphonates and the fact that tooth extraction is one of the most common dental procedures can explain why numerous patients necessitate tooth extractions while on bisphosphonate therapy. We suggest a specific and effective treatment protocol and believe that tooth extraction in this group of patients does not constitute a contraindication, for it can be uneventfully and successfully performed. http://dx.doi.org/10.1016/j.ijom.2015.08.858 Quality of end of life care in head and neck cancer in England 2003–2012 T. Walker 1,∗ , S. Thomas 1 , J. Verne 2 1 2
University of Bristol, Bristol, UK Public Health England, Bristol, UK
Background: Place of death can be used as a proxy marker for patient perceived quality of end of life care. Head and neck cancers can lead to difficult issues around the end of life. By examining the factors that influence place of death in head and neck cancer patients, we can begin to understand the issues affecting those who are dying, and help to plan appropriate services for them. Methods: Incidence data is collected from UK Cancer Information Service (CIS). Key data items used for this analysis (place
Mission tracker the first six months: web based solutions to integration of horizontal and vertical cleft care in the developing world T. Walker 1,∗ , P. Coles 2 , P. Ayliffe 3 , C. Mills 3 1
University of Bristol, Bristol, UK Accenture, London, UK 3 Great Ormond Street Hospital, London, UK 2
Background: Humanitarian cleft missions fill a temporal gap in local service provision in the developing world. This can be variable in terms of frequency and geography. The vertical nature of these can prevent the development of horizontally integrated locally sustainable clinical networks for the management of children with clefts. Many children receive excellent surgical treatment, however there is marked inequity and inequality between the services provided to children in the developing and developed world. We present a tech solution that will lead to the development of specialist treatment centres in the developing world that are sustainable, and will allow full horizontal integration and support to local service providers. Methods: A web portal would allow verified registration of cleft surgical missions in terms of location, dates, contact details and biographies of team members. Interactive map and calendaring as well as search facility would be available. Basic social networking functionality would allow contact between groups, as well as discussion fora and file sharing. Results: We will take this opportunity to present the results of the first six months of Mission Tracker, the issues that we have come across and over come since its launch in April 2015. Conclusions: Global cleft mission co ordination will allow, country by country, the development of specialist cleft centers that can host missions and provide a home for the charity funded multi disciplinary team and give children in the developed world the appropriate multi disciplinary treatment that vertical humanitarian mission cannot provide. http://dx.doi.org/10.1016/j.ijom.2015.08.860