• No results found

VU Research Portal

N/A
N/A
Protected

Academic year: 2021

Share "VU Research Portal"

Copied!
6
0
0

Bezig met laden.... (Bekijk nu de volledige tekst)

Hele tekst

(1)

VU Research Portal

Health-related quality of life and survival in patients with head and neck cancer

van Nieuwenhuizen, A.J.

2020

document version

Publisher's PDF, also known as Version of record

Link to publication in VU Research Portal

citation for published version (APA)

van Nieuwenhuizen, A. J. (2020). Health-related quality of life and survival in patients with head and neck

cancer: First steps towards improved survivorship care.

General rights

Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain

• You may freely distribute the URL identifying the publication in the public portal ?

Take down policy

If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

E-mail address:

(2)
(3)



&KDSWHUSURYLGHVEDFNJURXQGLQIRUPDWLRQRQKHDGDQGQHFNFDQFHU +1& KHDOWK UHODWHGTXDOLW\RIOLIH +54R/ DQGFDQFHUVXUYLYRUVKLSZLWKDVSHFLDOIRFXVRQSK\VLFDO activity. HNC encompasses tumors in the upper respiratory or digestive tract. To date, +1&LVWKHVL[WKOHDGLQJW\SHRIFDQFHUZRUOGZLGHZLWKDSSUR[LPDWHO\QHZ FDVHVLQDQGD\HDUVXUYLYDOUDWHRIDSSUR[LPDWHO\7UHDWPHQWIRUSDWLHQWV ZLWK +1& RIWHQ LQYROYHV VXUJHU\ UDGLRWKHUDS\ FKHPRWKHUDS\ RU D FRPELQDWLRQ RI these modalities. As a consequence of HNC and its treatment, many patients face SK\VLFDODQGSV\FKRVRFLDOSUREOHPV$GGLWLRQDOO\WKH\PD\EHFRQIURQWHGZLWKYHU\ VSHFL¿F SUREOHPV VXFK DV RUDO G\VIXQFWLRQ VZDOORZLQJ DQG VSHHFK SUREOHPV 7KLV PD\ KDYH D GLVWLQFW LPSDFW RQ WKH +54R/ RI SDWLHQWV ZLWK +1& ,QWHUHVWLQJO\ WKH FRXUVHRI+54R/KDVVKRZQWREHZRUVHLQQRQVXUYLYRUVRI+1&FRPSDUHGWR+1& VXUYLYRUVGXULQJWKH¿UVW\HDUVDIWHUWUHDWPHQW,QDGGLWLRQSUHYLRXVVWXGLHVVKRZHG DQ VLJQL¿FDQW DVVRFLDWLRQ EHWZHHQ +54R/ DQG VXUYLYDO LQGHSHQGHQWO\ IURP RWKHU known demographic, lifestyle-related and clinical factors.

,QFDQFHUVXUYLYRUVKLSSURPRWLQJDKHDOWK\OLIHVW\OHLVFULWLFDO,QSDWLHQWVZLWK+1& awareness of lifestyle-related factors such as smoking, alcohol use and nutritional VWDWXVVHHPVWREHHPLQHQW+RZHYHUOLWWOHLQIRUPDWLRQLVDYDLODEOHRQSK\VLFDODFWLYLW\ Two key gaps in knowledge were addressed in this thesis. First, it is still unclear which +54R/GRPDLQVDUHDVVRFLDWHGZLWKVXUYLYDOLQ+1&DWZKLFKWLPHSRLQWDFURVVWKH FDQFHUMRXUQH\DQGZKHWKHUDEVROXWHYDOXHVDQGRUFKDQJHVLQ+54R/DUHDVVRFLDWHG ZLWKVXUYLYDO6HFRQGPRUHNQRZOHGJHRQ+54R/LQ+1&VXUYLYRUVKLSLVQHHGHGDQG HVSHFLDOO\RQWKHUROHRISK\VLFDODFWLYLW\DQGWKHDVVRFLDWLRQZLWK+54R/7KHUHIRUH WKLVWKHVLVDLPVWRLQYHVWLJDWHWKHDVVRFLDWLRQEHWZHHQ+54R/DQGVXUYLYDOLQSDWLHQWV with HNC, and to investigate physical activity levels in long-term HNC survivors and WKHDVVRFLDWLRQZLWK+54R/

&KDSWHU  UHYLHZHG OLWHUDWXUH RQ +54R/ LQ SDWLHQWV ZLWK +1& +54R/ VHHPV DQ LQGHSHQGHQWSUHGLFWRURIVXUYLYDOEXWWKLVDVVRFLDWLRQPD\EHLQÀXHQFHGE\YDULRXV FDQFHUUHODWHG SHUVRQDO ELRORJLFDO SV\FKREHKDYLRXUDO SK\VLFDO OLIHVW\OHUHODWHG DQGVRFLDOIDFWRUV/HVVLVNQRZQDERXWWKHFRXUVHRI+54R/RYHUWLPHDQGDERXWWKH VDPHDERYHPHQWLRQHGSRVVLEOHIDFWRUVDVVRFLDWHGZLWK FKDQJHLQ +54R/LQSDWLHQWV ZLWK+1&6\PSWRPPDQDJHPHQWDQGSV\FKRVRFLDOFDUHPD\EHEHQH¿FLDOIRU+1& SDWLHQWVWRLPSURYH+54R/EXWPRUHUDQGRPLVHGFRQWUROOHGWULDOVDUHQHHGHG6WXGLHV RQ +54R/ LQ +1& DUH PRVW RIWHQ EDVHG RQ FURVVVHFWLRQDO GHVLJQV 7KH YDULDELOLW\ LQ RXWFRPH PHDVXUHV KDPSHUV WKH JHQHUDOL]DELOLW\ RI WKH UHVXOWV RI WKHVH VWXGLHV ,QIRUPDWLRQRQ+54R/RIFDUHJLYHUVLVVFDUFH%HWWHULQIRUPDWLRQRQDOODVSHFWVRIWKH FRXUVHRI+54R/IURPGLDJQRVLVDQGWUHDWPHQWWRORQJWHUPVXUYLYRUVKLSRUGHDWKLV KLJKO\QHHGHGLQERWKSDWLHQWVDQGWKHLUFDUHJLYHUV0RUHHYLGHQFHRQWKHḢFDF\RI QHZ WUHDWPHQWRSWLRQVV\PSWRPPDQDJHPHQWDQGSV\FKRVRFLDOFDUHLVQHHGHGDOVR

(4)



LQWKHFRQWH[WRILQFUHDVLQJORQJWHUPVXUYLYDODQGWKHJURZLQJDWWHQWLRQIRUFDQFHU survivorship.

&KDSWHUVSHFL¿FDOO\VWXGLHGWKHDVVRFLDWLRQEHWZHHQ+54R/DQGVXUYLYDOLQSDWLHQWV with HNC via a systematic review of prospective studies. A systematic search was FRQGXFWHGLQIRXUHOHFWURQLFELEOLRJUDSKLFGDWDEDVHV:HLQFOXGHGVWXGLHVSXEOLVKHG XS WR -DQXDU\  SURYLGLQJ GDWD RQ +54R/ DQG VXUYLYDO DQG WKH DVVRFLDWLRQ EHWZHHQ+54R/DQGVXUYLYDODPRQJ+1&SDWLHQWV7ZRUHVHDUFKHUVLQGHSHQGHQWO\ SHUIRUPHGDTXDOLW\UDWLQJ$EHVWHYLGHQFHV\QWKHVLVZDVDSSOLHGWRGUDZFRQFOXVLRQV ,Q WRWDO QLQHWHHQ VWXGLHV ZHUH LQFOXGHG 7ZHOYH VWXGLHV LQFOXGHG DOO VXEVFDOHV RI D +54R/ TXHVWLRQQDLUH DQG VHYHQ VWXGLHV IRFXVHG RQ VSHFL¿F VXEVFDOHV 7KH PHDQ TXDOLW\VFRUHZDV“DQGRIWKHVWXGLHVZHUHRIKLJKTXDOLW\$FFRUGLQJWRWKH EHVWHYLGHQFHV\QWKHVLVWKHUHZDVVWURQJHYLGHQFHIRUDSRVLWLYHDVVRFLDWLRQEHWZHHQ SUHWUHDWPHQW SK\VLFDO IXQFWLRQLQJ DQG VXUYLYDO DQG EHWZHHQ FKDQJH LQ JOREDO 4R/ IURP SUHWUHDWPHQW WR  PRQWKV DIWHU WUHDWPHQW DQG VXUYLYDO 'XH WR LQFRQVLVWHQW ¿QGLQJV WKHUH ZDV LQVẊFLHQW HYLGHQFH IRU DQ DVVRFLDWLRQ ZLWK VXUYLYDO RI RWKHU +54R/GRPDLQVLQFOXGLQJUROHHPRWLRQDOFRJQLWLYHDQGVRFLDOIXQFWLRQLQJPHQWDO KHDOWKDQGZHOOEHLQJ7KLVFKDSWHUKLJKOLJKWVWKHQHHGIRUKLJKTXDOLW\VWXGLHVZLWKD ORQJLWXGLQDOGHVLJQWRH[DPLQHWKHFRPSOH[DVVRFLDWLRQVEHWZHHQ+54R/DQGVXUYLYDO &KDSWHUGHVFULEHVDFRKRUWVWXG\LQZKLFKWKHDVVRFLDWLRQVEHWZHHQ+54R/ DVVHVVHG SUHWUHDWPHQWSRVWWUHDWPHQWDQGFKDQJHLQ+54R/ DQGVXUYLYDOZDVH[DPLQHGLQ SDWLHQWVZLWK+1&:HLQFOXGHGGL̆HUHQWWLPHSRLQWVDORQJWKHFDQFHUWUDMHFWRU\ SUH WUHDWPHQWSRVWWUHDWPHQWDQGFKDQJHLQ+54R/ 7KHVWXG\LQFOXGHG SDWLHQWV QHZO\GLDJQRVHGZLWK+1& RUDOFDYLW\RURSKDU\Q[K\SRSKDU\Q[DQGODU\Q[ WUHDWHG ZLWKSULPDU\RUDGMXYDQW FKHPR UDGLRWKHUDS\ZLWKFXUDWLYHLQWHQW+54R/ (257& 4/4& ZDVDVVHVVHGSUHWUHDWPHQWDQGDWZHHNVPRQWKVDQGPRQWKVDIWHU FRPSOHWLRQ RI WUHDWPHQW 0XOWLYDULDEOH &R[ UHJUHVVLRQ DQDO\VHV ZHUH SHUIRUPHG WR H[DPLQHZKHWKHUSUHWUHDWPHQW+54R/SRVWWUHDWPHQW+54R/RUFKDQJHLQ+54R/ were associated with survival, after adjusting for demographic, clinical and lifestyle UHODWHGYDULDEOHV+54R/ZDVVLJQL¿FDQWO\DVVRFLDWHGZLWKVXUYLYDODWDOOWLPHSRLQWV H[FHSWIRUWKHVXEVFDOHJOREDO4R/DWZHHNVSRVWWUHDWPHQW$FKDQJHLQ+54R/LQ WKH¿UVWZHHNVZDVQRWDVVRFLDWHGZLWKVXUYLYDO&KDQJHVLQSK\VLFDODQGHPRWLRQDO IXQFWLRQLQJ IURP SUHWUHDWPHQW WR  PRQWKV SRVWWUHDWPHQW DQG FKDQJHV LQ JOREDO 42/DQGSK\VLFDOHPRWLRQDODQGVRFLDOIXQFWLRQLQJIURPSUHWUHDWPHQWWRPRQWKV SRVWWUHDWPHQWZHUHVLJQL¿FDQWO\DVVRFLDWHGZLWKVXUYLYDO

&KDSWHUGHVFULEHVWKHUHVXOWVRIDFURVVVHFWLRQDOVWXG\WKDWDLPHGWRDVVHVVSDWLHQW UHSRUWHG OHYHOV RI SK\VLFDO DFWLYLW\ DQG LWV DVVRFLDWLRQ ZLWK +54R/ DGMXVWHG IRU

(5)



UHOHYDQWGHPRJUDSKLFOLIHVW\OHUHODWHGDQGFOLQLFDOIDFWRUVDPRQJ+1&VXUYLYRUV 3K\VLFDODFWLYLW\ZDVDVVHVVHGZLWKWKH3K\VLFDO$FWLYLW\6FDOHIRUWKH(OGHUO\ 3$6(  DQG+54R/ZLWKWKH(257&4/4&DQG(257&+1$VVRFLDWLRQVZHUHVWXGLHG XVLQJ XQLYDULDEOH DQG PXOWLYDULDEOH UHJUHVVLRQ DQDO\VHV 0HGLDQ 3$6( VFRUH ZDV  LQWHUTXDUWLOHUDQJH RIZKLFKZHUHKRXVHKROGOHLVXUHWLPH DQGRFFXSDWLRQDODFWLYLWLHV<RXQJHU+1&VXUYLYRUVKDGKLJKHUOHYHOVRISK\VLFDO DFWLYLW\+LJKHUSK\VLFDODFWLYLW\ZDVVLJQL¿FDQWO\DVVRFLDWHGZLWKKLJKHUJOREDO4R/ Findings for physical function, role function, social function, fatigue and pain were in OLQHEXWQRWVWDWLVWLFDOO\VLJQL¿FDQW7KHVHUHVXOWVLQGLFDWHVWKDWLPSURYLQJSK\VLFDO DFWLYLW\PLJKWEHDQLQWHUYHQWLRQWDUJHWWRLPSURYH+54R/+RZHYHUGXHWRWKHFURVV VHFWLRQDOGHVLJQLWLVQRWSRVVLEOHWRPDNHFDXVDOLQIHUHQFHVDQGLWLVXQFOHDUZKHWKHU LPSURYLQJSK\VLFDODFWLYLW\OHYHOVZRXOGLPSURYH+54R/RUZKHWKHU+1&VXUYLYRUV ZLWKORZHU+54R/DUHOHVVSK\VLFDOO\DFWLYH 7REHDEOHWRXQUDYHOFRPSOH[DVVRFLDWLRQVEHWZHHQFDQFHUUHODWHGSHUVRQDOJHQHWLF ELRORJLFDO SV\FKREHKDYLRXUDO SK\VLFDO OLIHVW\OHUHODWHG DQG VRFLDO IDFWRUV DQG survival in patients with HNC, a cohort study among a large group of patients with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̆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the Netherlands. ,Q&KDSWHUWKHPDLQ¿QGLQJVRIWKLVWKHVLVDUHGLVFXVVHGDVZHOODVWKHPHWKRGRORJLFDO considerations, implications for clinical practice and recommendations for further

(6)



UHVHDUFK ,W LV FRQFOXGHG WKDW +54R/ LV DQ LPSRUWDQW RXWFRPH LQ +1& WUHDWPHQW 7ZRNH\JDSVLQNQRZOHGJHZHUHDGGUHVVHGLQWKLVWKHVLV,WZDVVWLOOXQFOHDUZKLFK +54R/GRPDLQVDUHDVVRFLDWHGZLWKVXUYLYDOLQ+1&DWZKLFKWLPHSRLQWDFURVVWKH FDQFHUMRXUQH\DQGZKHWKHUDEVROXWHYDOXHVDQGRUFKDQJHVLQ+54R/DUHDVVRFLDWHG ZLWKVXUYLYDO3UHWUHDWPHQWSK\VLFDOIXQFWLRQDQGFKDQJHVLQSK\VLFDODQGHPRWLRQDO IXQFWLRQ LQ WKH ¿UVW \HDU DIWHU WUHDWPHQW DUH VLJQL¿FDQWO\ DVVRFLDWHG ZLWK VXUYLYDO 6HFRQGO\PRUHNQRZOHGJHRQ+54R/LQ+1&VXUYLYRUVKLSZDVQHHGHGDQGHVSHFLDOO\ the role of physical activity. HNC survivors are not physically active (especially older +1& VXUYLYRUV  ZKLFK LV DVVRFLDWHG ZLWK ORZHU +54R/ 7KLV WKHVLV FRQWULEXWHV WR IXUWKHU DGYDQFLQJ LQWHUGLVFLSOLQDU\ UHVHDUFK RQ +54R/ LQ +1& DQG PD\ KHOS WR develop care pathways with a more patient centred approach.

Referenties

GERELATEERDE DOCUMENTEN

EORRG SUHVVXUH DQG FUHDWLQLQH FOHDUDQFH DW WKH DJH RI  \HDUV XS WR WKH DJH RI.  \HDUV &amp;KDSWHU IRXU GHVFULEHV WKH DVVRFLDWLRQ EHWZHHQ EORRG

WR ZKDW H[WHQW WKH SUHFLSLWDWLQJ RIIHQGHU DQG WKH YLFWLP DUH HDFK WR EODPH IRU ZKDW. KDSSHQHGRQDSRLQWVFDOH

ZHUH GHPRQVWUDWHG ZLWK UHJDUG WR UHYHUVH /9 DQG DWULDO UHPRGHOLQJ DIWHU 50$     DQG SURPLVLQJ  DQG  \HDU VXUYLYDO UDWHV RI  DQG

7KHVWXGLHVGHVFULEHGLQ&amp;KDSWHUV 7DEOH XVHGGL൵HUHQWPHWKRGVRIGDWDFROOHFWLRQ

 &amp;DGKHULQDQGQRW(FDGKHULQZDVIRXQGWREHH[SUHVVHGLQ)/6IURPKHDOWK\

%RWKVHWVLQFOXGHGWZRZRUGVFRQWUDVWLQJLQFRORUVL]HQXPEHUDQGIRUP6HW LQFOXGHGOLTXRULFHV±VQRZ FRORU UDEELW±PDQ VL]H EDOO±ERRN IRUP

%URRGV RI $VWDWRUHRFKURPLV DOOXDXGL DQG +DSORFKURPLV LVKPDHOL ZHUH VSOLW DQG H[SRVHGWRQRUPR[LD DLUVDWXUDWLRQ DQGK\SR[LD DLUVDWXUDWLRQ

:HLQYHVWLJDWHGWKHYDULDWLRQLQWHDFKHUV·SHUVSHFWLYHVLQDVPDOOVFDOHLQWHUYLHZ VWXG\ Q   DQG LGHQWLILHG WKH IROORZLQJ IRXU SHUVSHFWLYHV