JAMA otolaryngology-- head & neck surgery最新文献

{"title":"Stress, Employment Changes, and Psychological Distress Among Caregivers of Patients With Head and Neck Cancer.","authors":"Lama Abdurrahman, Vlad C Sandulache, Cielito Reyes-Gibby, Erich M Sturgis, Pavan Jhaveri, Hoda Badr","doi":"10.1001/jamaoto.2025.0131","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0131","url":null,"abstract":"<p><strong>Importance: </strong>Patients undergoing external beam radiation therapy (EBRT) for head and neck cancer (HNC) often experience adverse effects that require substantial caregiving. The burdens of caregiving can impact caregiver employment and mental health over time, yet this topic remains underexplored.</p><p><strong>Objective: </strong>To examine the associations between caregiving for patients with HNC who undergo EBRT and caregiver stress, employment status, and psychological distress.</p><p><strong>Design, setting, and participants: </strong>This was a secondary analysis of data from a longitudinal survey study that surveyed caregivers at baseline (ie, at initiation of EBRT) and at 4-month and 12-month follow-ups. The study was conducted at 2 comprehensive cancer centers in Houston, Texas, and New York, New York, and included patients with HNC who had undergone EBRT and their caregivers. Data were collected from September 1, 2009, to August 31, 2014, and were analyzed from June 1, 2024, to August 31, 2024.</p><p><strong>Main outcomes and measures: </strong>The primary outcomes included caregiver employment status and psychological distress level, the latter of which was measured using the Brief Symptom Inventory-18 (BSI-18) for general distress and the Impact of Event Scale-Revised (IES-R) for cancer-specific distress.</p><p><strong>Results: </strong>The study included 188 caregivers, 159 (84.6%) of whom were female; the mean (SD) age for all caregivers was 54.6 (10.4) years. At baseline, 53 caregivers (28.2%) met BSI-18 criteria for general distress, and 85 (45.2%) met IES-R criteria for cancer-specific distress. By the 12-month follow-up, these rates decreased to 16 of 112 (14.3%) and 30 of 112 (26.8%), respectively. Caregivers were 40% less likely to be employed full-time at the 4-month follow-up (odds ratio, 0.60 [95% CI, 0.48-0.75]), and this reduction persisted with a 41% lower likelihood of full-time employment at the 12-month follow-up (odds ratio, 0.59 [95% CI, 0.47-0.74]). Caregivers who reduced their work hours or exited the workforce during the entire study period (n = 48 [25.5%]) reported higher levels of general distress (β = 4.02 [95% CI, 0.65-7.39]). Furthermore, greater role captivity (β = 5.37 [95% CI, 2.12-8.63]) and lower caregiving competence (β = -3.84 [95% CI, -6.21 to -1.47]) were associated with elevated levels of both general distress and cancer-specific distress.</p><p><strong>Conclusions and relevance: </strong>The findings of this survey study suggest that caregiving for patients with HNC undergoing EBRT may be associated with lower employment rates and poorer mental health among caregivers. Integrating caregivers into multidisciplinary HNC care to identify those at risk and connecting them to timely employment-based interventions such as flexible work arrangements and caregiver leave, as well as community-based support services such as counseling and social network-building, could help alleviate the d","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11986827/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External Auditory Canal Stenosis in a Child.","authors":"Keelin Fallon, Caroline Robson, Aaron Remenschneider","doi":"10.1001/jamaoto.2025.0251","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0251","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking Depression and Head and Neck Cancer-Reply.","authors":"Michelle M Chen","doi":"10.1001/jamaoto.2025.0189","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0189","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking Depression and Head and Neck Cancer.","authors":"Selena K Zhang, John P Dempsey, Alexandra Balshi","doi":"10.1001/jamaoto.2025.0205","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0205","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflections on Electronic Health for Head and Neck Cancer-Insights into Patient-Centered Palliative Care-Reply.","authors":"Boyd N van den Besselaar, Kira S van Hof, Marinella P J Offerman","doi":"10.1001/jamaoto.2025.0191","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0191","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143991825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Considering Cohort Heterogeneity, Incorporating Frequency-Specific Classifications, and Adopting Longitudinal Designs-Reply.","authors":"Jing Wang, Valerie Sung, Melissa Wake","doi":"10.1001/jamaoto.2025.0188","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0188","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Considering Cohort Heterogeneity, Incorporating Frequency-Specific Classifications, and Adopting Longitudinal Designs.","authors":"Xiaohui Zhu, Yuan Ren, Kai Wang","doi":"10.1001/jamaoto.2025.0202","DOIUrl":"https://doi.org/10.1001/jamaoto.2025.0202","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143772108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lung Cancer Surveillance for Patients With Head and Neck Cancer.","authors":"Naif Fnais, Francisco Laxague, Marco A Mascarella, Raisa Chowdhury, Hedi Zhao, Sukhdeep Jatana, Abrar Aljassim, Catherine F Roy, Abdulaziz S Alrasheed, David S Chan, Jason Agulnik, Reza Forghani, Khalil Sultanem, Alex Mlynarek, Michael P Hier","doi":"10.1001/jamaoto.2024.3738","DOIUrl":"10.1001/jamaoto.2024.3738","url":null,"abstract":"<p><strong>Importance: </strong>Patients with head and neck squamous cell cancer (HNSCC) are at a greater risk of developing pulmonary metastases and/or second primary lung cancer. However, it remains uncertain whether lung screening in these patients, when the initial staging studies are negative, confers any survival benefit.</p><p><strong>Objective: </strong>To evaluate long-term cancer survival outcomes in patients with HNSCC undergoing chest radiography vs low-dose computed tomography screening for pulmonary metastasis and/or second primary lung cancer.</p><p><strong>Design, setting, and participants: </strong>This randomized parallel trial was conducted at a large academic hospital in Canada enrolling treatment-naive patients with de novo HNSCC from September 2015 to December 2022. Eligible patients did not meet the criteria for lung screening established by the US National Comprehensive Cancer Network guidelines. Participants were randomized to chest radiography or low-dose computed tomography screening groups. Data were analyzed from March to August 2024.</p><p><strong>Intervention or exposure: </strong>Comparison of chest radiography vs low-dose computed tomography screening methods.</p><p><strong>Main outcomes and measures: </strong>Primary outcomes were the lung cancer detection rate measured by comparing the sensitivity and specificity of low-dose computed tomography with chest radiography. Secondary outcomes were overall survival and disease-free survival.</p><p><strong>Results: </strong>A total of 137 patients (mean [SD] age, 65.1 [14.1] years; 34 [24.8%] females and 103 [75.2%] males) were included and randomized, 68 (49.6%) to chest radiography and 69 (50.4%) to low-dose computed tomography. Nine of 137 patients (6.5%) developed a second primary lung cancer (6 patients) or lung metastases (3 patients). There were no clinically meaningful differences in survival outcomes between the 2 groups (hazard ratio, 1.2; 95% CI, 0.4-3.9). Chest radiography exhibited a relatively low sensitivity of 66.7% but a specificity of 100%. Low-dose computed tomography demonstrated both high sensitivity (100%) and specificity (100%), for an overall accuracy of 100%.</p><p><strong>Conclusions and relevance: </strong>The findings of this randomized parallel trial indicate that low-dose computed tomography exhibits statistically significant superior sensitivity compared with chest radiography for diagnosing lung metastases and second primary lung cancer. However, there were no important differences in survival rates. These results hold practical significance, offering valuable insights to clinicians who are guiding decisions regarding lung screening protocols.</p><p><strong>Trial registration: </strong>ISRCTN10954990.</p>","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"328-334"},"PeriodicalIF":6.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11886864/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concerns Regarding Mouth Closure and Airflow in Obstructive Sleep Apnea.","authors":"Yu-Ting Lin, Chi-Yu Liao, Chia-Hao Hsu","doi":"10.1001/jamaoto.2024.5073","DOIUrl":"10.1001/jamaoto.2024.5073","url":null,"abstract":"","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"414-415"},"PeriodicalIF":6.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Manual Therapy for Fibrosis-Related Late Effect Dysphagia in Head and Neck Cancer Survivors: The MANTLE Nonrandomized Clinical Trial.","authors":"Holly McMillan, Carla L Warneke, Sheila Buoy, Christine Porsche, Kiara Savage, Stephen Y Lai, Clifton D Fuller, Katherine A Hutcheson","doi":"10.1001/jamaoto.2024.5157","DOIUrl":"10.1001/jamaoto.2024.5157","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Late radiation-associated dysphagia (RAD) after head and neck cancer (HNC) treatment is challenging and commonly treatment refractory, with fibrosis stiffening connective tissues and compressing peripheral nerve tracts, contributing to diminished strength and possibly denervation of swallowing muscles. Manual therapy (MT), while common for cancer-related pain and other indications, remains largely unstudied for fibrosis-related late RAD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine the feasibility and safety of MT, estimate effect size and durability of MT for associated improvements in cervical range of motion (CROM), and examine functional outcomes after MT in survivors of HNC with fibrosis-related late RAD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;This nonrandomized clinical trial, Manual Therapy for Fibrosis-Related Late Effect (MANTLE) Dysphagia in Head and Neck Cancer Survivors, is a prospective, single-institution, pilot, single-arm supportive care trial conducted at a National Comprehensive Cancer Network-designated academic comprehensive cancer center. Participants were adult survivors of HNC who were disease free at 2 or more years after curative-intent radiotherapy with grade 2 or higher fibrosis (per Common Terminology Criteria for Adverse Events version 4.0) and grade 2 or higher dysphagia (per video fluoroscopy Dynamic Imaging Grade of Swallowing Toxicity [DIGEST]). Data were collected June 2018 to July 2021 and analyzed November 2022 to November 2024.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;MANTLE included 10 hourly MT sessions by lymphedema-certified speech-language pathologists over 6 weeks with a home exercise program. During the subsequent 6-week washout period, participants implemented only the home exercise program, without clinician MT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Outcomes and measures: &lt;/strong&gt;Primary end points were feasibility (per therapy completion rate, with a 75% target) and safety. Secondary end points included functional outcomes per CROM, dysphagia severity (per DIGEST), maximum interincisal opening (MIO), and validated participant-reported outcomes (PROs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 24 survivors of HNC (20 male [83.3%]; median [range] age, 68 [53-80] years), there was a median (range) of 8.9 (2.4-30.2) years after curative-intent radiotherapy. A total of 22 participants (91.7%) completed the 10 prescribed therapy sessions, and 1 participant experienced a severe adverse event. Secondary end points improved among participants who completed the therapy: MIO (r = 0.76; 95% CI, 0.66 to 0.94) and all 6 planes of CROM (eg, cervical extension: r = 0.86; 95% CI, 0.83 to 0.93) improved, with large effect sizes from baseline to after MT. Large to moderate effect sizes were achieved in symptom measures per PROs (eg, lymphedema-fibrosis symptom severity after MT: r = 0.74; 95% CI, 0.63 to 0.99). However, effect sizes were small to moderate or null in uncompensated swallowing outcom","PeriodicalId":14632,"journal":{"name":"JAMA otolaryngology-- head & neck surgery","volume":" ","pages":"319-327"},"PeriodicalIF":6.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11803512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143255680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}