“Return to work, back to life” for head and neck cancer survivors
According to the Indian national cancer registry (DOI: 10.1200/GO.20.00122), head and neck cancers (head and neck squamous cell carcinoma [HNSCC]) constitute 30% of the cancer burden in India. With advances in therapy, their survival rates have also increased. Return to work (RTW) is an independent indicator of quality of life (QOL) of cancer survivors (https://doi.org/10.3390/cancers130614002). Treatment strategies for HNSCC have significant side effects impacting the QOL in the long run. Knowledge of factors influencing RTW may help improve their QOL.
A systematic review and meta-analysis done by Justin Yu et al. was published in the head and neck journal in September 2022 (https://doi.org/10.1002/hed.27197). It analyzed 21 articles looking at the ability of the head and neck cancer survivors to RTW. It also included analysis on reduced working hours and compared the QOL of the RTW group with non-RTW group. This study showed a 67% prevalence of RTW in patients who were employed before starting treatment. Pooled analysis of five studies showed that reduced working hours were noted in 44% patients, while 30% had to change their occupation. A meta-analysis of nine studies using Hospital Anxiety Depression Scale (HADS) demonstrated twice as less anxiety and depression in RTW survivors compared to those who did not RTW, showing the positive impact of RTW on patients' psychosocial well-being. Subgroup analysis showed higher RTW rate in oropharyngeal cancer than other subsites. However, significant heterogeneity was noted in these studies reporting RTW outcome. This was probably due to differences in the sociodemographic and clinical characteristics as well as the measurement of RTW. For example, the inclusion criteria were distinct, with some studies including only employed patients at the time of diagnosis. The head and neck cancer subsites as well as age criteria were also dissimilar.
Multiple factors affect the process of returning to and remaining at work. Delay may be associated with older age at diagnosis, female gender, comorbidities, and advanced stage. Also, anxiety and oral dysfunction leading to problems of social eating may contribute to decrease in RTW. Indian data published by Agarwal et al. earlier in the same journal (doi: 10.1002/hed. 24703) showed family structure, higher level of education, and female gender to be associated with higher RTW.
Present systematic review highlights the importance of RTW with its impact on QOL. Issues involving financial status, education, human papillomavirus (HPV) status, dietary styles, habits (tobacco and alcohol), and employment rates can also impact QOL. Prospective studies are further warranted to understand better the QOL and RTW in head and neck cancer survivors.
Kantamani Bala Teja
Olanzapine – Savior drug for prevention of chemotherapy-induced nausea and vomiting in children with cancer
Chemotherapy-induced nausea and vomiting (CINV) are two of the most common and worst-feared toxicities of cancer chemotherapy. Over the last decade, antiemetic regimens have improved in adult patients, but only a few trials have studied pediatric patients. Olanzapine, a second-generation atypical antipsychotic agent, has been approved for adult patients to prevent CINV. The All India Institute of Medical Sciences (AIIMS), New Delhi, conducted the first large randomized, open-label, Phase III clinical trial to evaluate the use of olanzapine in children scheduled to receive the first cycle of highly emetogenic chemotherapy (HEC) (http://ascopubs.org/doi/full/10.1200/JCO.20.00871).
A total of 240 chemotherapy-naïve children (aged 5–18 years) scheduled to receive the first cycle of HEC were analyzed (116 in the control group and 115 in the study group). All participants received aprepitant (80/80/80 mg for 15–40 kg and 125/80/80 mg for >40 kg on days 1–3), ondansetron (0.15 mg/kg every 8 h), and dexamethasone (3 mg/m2 every 8 h) during and 2 days after chemotherapy. Participants in the study group additionally received oral olanzapine 0.14 mg/kg/day (maximum 10 mg) during and 3 days post-chemotherapy. The rescue medication used was oral or IV metoclopramide. The primary objective was to compare complete response (CR) rates (no vomiting and no rescue medication) between the groups in the acute, delayed, and overall periods. CINV after initiation to 24 h after completion of the chemotherapy was defined as acute CINV, and delayed CINV referred to the one which occurred 24–120 h after chemotherapy.
A higher proportion of patients in the olanzapine group than those in the control group achieved CR in the acute period (78% vs. 59%, P = 0.001), delayed period (74% vs. 47%, P = 0.001), and overall period (64% vs. 38%, P = 0.001). The proportion of patients with no nausea was significantly higher in the olanzapine group in the acute period (74% vs. 52%, P = 0.001), delayed period (74% vs. 47%, P = 0.001), and overall period (64% vs. 37%, P = 0.001). Grade 1/2 somnolence was greater in the olanzapine group (35% vs. 11%, P = 0.001). There was no grade 3/4 somnolence reported.
The study concluded that olanzapine significantly improved the control of CINV during the acute, delayed, and overall periods in children and adolescents ages 5–18 years receiving the first cycle of HEC, with a tolerable safety profile.
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Conflicts of interest
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