Assessing Patient-Reported Outcomes: A Mixed Methods Qualitative Comparison Between Obturator and Surgically Reconstructed Maxillectomy Patients.

Abstract

Objectives: Cancers of the maxillary region are often treated surgically with a maxillectomy followed by rehabilitation involving surgical reconstruction or obturator insertion to improve functional outcomes. However, there is a lack of consensus regarding the specific indications for either rehabilitation method. The objective of this study was to identify unique functional domains for maxillectomy patients who underwent surgical reconstruction or obturator insertion post-op to provide standardized data that can inform selection of either method.

Methods: This mixed-methods qualitative research was conducted from January 2020 to June 2022 at London Health Sciences Centre, a tertiary care center in London, Ontario, Canada. Phase I included open-ended patient interviews through grounded theory, while phase II incorporated focus groups through the Delphi technique. Phase I identified functional domains of interest, which were further refined based on importance to patients in phase II. Inclusion criteria consisted of adults, 18 years or older who underwent maxillectomy surgery for head and neck cancer.

Results: A total of 22 patients were included in phase I and 8 patients were included in phase II. The top 4 functional domains that affected patients regardless of rehabilitation method were eating difficulties, speaking difficulties, social discomfort with public eating, and numbness. The top 4 unique functional domains identified for the surgical group were dry mouth, trismus, chewing difficulties, and eye-related symptoms. The top 4 unique functional domains for the obturator group were obturator discomfort, nasal regurgitation, weight loss, and voice changes.

Conclusions: This study identified functional domains affecting maxillectomy patients, which can be used to inform decisions regarding selection of rehabilitation method in clinical practice. This data can also in the future to create the first patient-reported outcomes instrument for this patient population.