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Disability in Patients With Head and Neck Cancer
Joseph C. Taylor, MD;
Jeffrey E. Terrell, MD;
David L. Ronis, PhD;
Karen E. Fowler, MPH;
Carol Bishop, MS, RN;
Michael T. Lambert, MD;
Larry L. Myers, MD;
Sonia A. Duffy, PhD, RN; and The University of Michigan Head and Neck Cancer Team
Arch Otolaryngol Head Neck Surg. 2004;130:764-769.
Background Patients with head and neck cancer often experience debilitating speech, eating, and respiratory problems as well as the psychological effects of loss of function and change in body image. These patients often become unemployed as a result of their disease process, which adds financial burden to their already stressful lives. Yet the specific factors associated with unemployment have not been systematically studied.
Methods This multisite study used survey and chart data to determine the predictors of work-related disability.
Results Of the 384 patients who were working prior to their diagnosis of head and neck cancer, 52% (n = 201) were disabled by their cancer treatment. Multivariate analysis demonstrated significant links between disability and chemotherapy (odds ratio [OR], 3.4; P <.001), neck dissection status (OR, 2.3; P = .01), pain scores (OR, 1.2; P = .01), and time since diagnosis (OR, 0.9; P = .04).
Conclusions More than half of the patients in this study were disabled by their head and neck cancer or treatment. Patients with head and neck cancer who have undergone chemotherapy or neck dissection or have high pain scores are at increased risk for disability from their cancer or their treatment. Efforts to prevent (if possible), better assess, and treat pain and other adverse effects of head and neck cancer treatments may also have the potential to reduce patient disability.
From the Department of Otolaryngology, University of Michigan (Drs Taylor, Terrell, and Duffy), Ann Arbor Veterans Affairs Hospital, Center of Practice Management and Outcomes Research (Drs Ronis and Duffy and Ms Fowler), and the University of Michigan School of Nursing (Dr Ronis), Ann Arbor; Department of Otolaryngology, Veterans Affairs Hospital, Gainesville, Fla (Ms Bishop); Departments of Psychiatry (Dr Lambert) and Otolaryngology (Dr Myers), University of Texas Southwestern Medical School Dallas; North Texas Veterans Health Care System, (Dr Lambert); and Department of Otolaryngology, Veterans Affairs Hospital (Dr Meyers), Dallas. The members of The University of Michigan Head and Neck Cancer Team, all of whom are authors of this article, are Carol R. Bradford, MD; Douglas B. Chepeha, MD; Norman D. Hogikyan, MD; Mark E. Prince, MD; Theodoros N. Teknos, MD; and Gregory T. Wolf, MD. Dr Prince is also with the Ann Arbor Veterans Affairs Hospital. The authors have no relevant financial interest in this article.
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