Page 44 - 7. FINAL draft Compendium 2019 2020_22072022

PATIENT CONCERNS INVENTORY HEAD & NECK AS AN INDIVIDUALISED APPROACH TO
ASSESS POST-TREATMENT OUTCOMES AMONG ORAL CANCER PATIENTS IN MALAYSIA
NMRR-18-3624-45010

Ainon NA, Jennifer GD, Siti Mazlipah I, Ma BC, Marzuki ZA, Cri Saiful JMB, Nurshaline PK, Lee CW

Introduction: Oral cancer and its treatment undisputedly impacts patients’ quality of life,
posing a challenge to clinicians in managing them optimally. Identifying patients’ concerns
is central to holistic patient care; as such time constraints faced by clinicians during
consultation sessions may pose a barrier in identifying such concerns effectively. The use
of Patients Concerns Inventory [PCI]-Head & Neck during post-treatment oral cancer
consultation sessions has previously shown to be beneficial, simultaneously promoting
effective patient- clinician communication during consultations. Objectives: This study
aimed to determine the feasibility of the PCI-H&N in assessing post-treatment oral cancer
patients concerns and its relationship with patients’ HRQoL, psychological distress and
satisfaction during their follow-up consultation. Materials and Methods: A mixed mode
study design was conducted among post-treatment oral cancer patients in multiple
centres of Oral Maxillofacial Surgery Clinics in Malaysia, in two phases; i) Phase I: 3-armed
pragmatic RCT among post-treatment oral cancer patients, and ii) Phase II: focus group
discussion among health personal. A sample of 123 post-treatment oral cancer patients
attending their follow-up reviews were recruited comprising Malaysians aged 18 years
and above, completed treatment and on follow-up from one month until five years or
more. A set of self-administered questionnaires was administered pre and post-
consultation. The primary outcomes were patients’ HRQoL assessed by the FACT-
H&Nv4.0, psychological distress by using Distress Thermometer and satisfaction with the
follow-up consultation measured by a study specific questionnaire. The feasibility and
preferred versions of PCI-H&N were secondary outcomes assessed with specific
questionnaires respectively. The data were analysed descriptively; multiple linear
regression and multivariate logistic regression analyses were used to determine possible
predictors of patients’ HRQoL and psychological distress. Results: Response rate was 88%
with 63% patients completing the post-consultation questionnaires. The median (IQR)
number of the PCI-H&N items selected was three (1-5.5) and 43.5% patients selected four
or more concerns. ‘Recurrence or fear of cancer coming back’ (31.8%) was most
frequently selected. A shorter time was taken by patients to complete the paper version
(4.0 + 3.7 mins; 95% CI: 3.87, 5.87) than the computerised web-based version (6.0 + 4.5
mins; 95% CI: 5.55, 8.92). A high number of concerns was strongly significant among
patients of ‘one-month to one-year post-treatment’ (n=84%) (p=0.001). Significant
association existed between ‘time after treatment completed’ and concerns of
‘chewing/eating’, ‘mouth opening’, ‘swelling’, ‘weight’,’ ability to perform’, ‘cancer
treatment’ and ‘supplement/ diet-related’. ‘Chewing/eating’ scored highly for predicting
low HRQoL (p< 0.0001) followed by ‘appearance’ and ‘ability to perform recreation
activities’ (personal function domain). Patients at risk of psychological distress were 14
times more likely to select ‘ability to perform recreation activities’ and 7 times more likely
to select ‘feeling depressed’. No significant association was identified between patient’s
satisfaction with the consultation and patients concerns.

22