Literature Review: A Roundup of Important Recent Studies

Bottom line: When compared with radiation alone, CRT significantly improved LED-FS as a suitable indicator for functional outcome. CRT was noted to increase acute, but not late, radiation-induced side effects without deterioration in QoL scores. Patient-reported xerostomia was more pronounced in patients treated by CRT, but this was not translated as significant deterioration on the functional scales. When compared with 3DCRT, IMRT significantly reduced acute and late toxicity.

Reference: Al-Mamgani A, Mehilal R, van Rooij PH, Tans L, Sewnaik A, Levendag PC. Toxicity, quality of life, and functional outcomes of 176 hypopharyngeal cancer patients treated by (chemo)radiation: the impact of treatment modality and radiation technique. Laryngoscope. 2013;122:1789-1795.

—Reviewed by Sue Pondrom

Psychological Impact of Wait Time for Thyroid Surgery

What is the degree of psychological morbidity in patients waiting for thyroid surgery?

Background: Waiting for health care is an important source of anxiety for Canadians. As of 2005, the province of Ontario has implemented a wait time system to improve access to surgical services: priority level 1 for immediate/urgent; priority level 2 for fewer than 14 days; priority level 3 for fewer than 28 days; and priority level 4 for fewer than 84 days. Most patients with thyroid cancer or indeterminate thyroid nodules are categorized as priority level 4. The degree of psychological distress patients experience during this wait is unknown.

Study design: Prospective assessment of patients’ pre- and post-operative psychological morbidity.

Setting: Department of Otolaryngology-Head and Neck Surgery, Department of Psychosocial Oncology and Palliative Care, Department of Endocrinology, University Health Network, Ontario Cancer Institute, University of Toronto; Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital; Department of General Surgery, Toronto General Hospital; Department of Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, Princess Margaret Hospital; Department of Otolaryngology-Head and Neck Surgery, Sunnybrook Health Sciences Center, Toronto, Ontario.

Synopsis: Patients waiting for thyroidectomy were mailed a sociodemographic and four psychological morbidity questionnaires: Impact of Event Scale-Revised (IES-R), Illness Intrusiveness Ratings Scale (IIRS), Perceived Stress Scale (PSS) and Hospital Anxiety and Depression Scale (HADS). Over a three-year period, the response rate was 53 percent for 176 patients providing pre-operative data and 42 percent completing post-operative data. Respondents with a suspicious or known malignancy waited an average of 107 days for thyroidectomy, while those with benign neoplastic biopsies waited an average of 218 days. Although respondents reported substantial psychological morbidity on all questionnaires, there was no significant association between psychological morbidity and wait times, clinical or sociodemographic factors. Post-operative anxiety decreased significantly for all measures except for the IIRS.