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JBR Journal of Interdisciplinary Medicine and Dental Science
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Assessment of Head and Neck Cancer Patient’s Co-Morbidity in Accordance to the International Classification of Functioning, Disability and Health

Zareena Z. Jangda1*, Afsheen Maqsood2, and Kehkishan Azam3

1Department of Dentistry, Civil hospital, University Road, Karachi, Pakistan.

2Department of Dentistry, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.

3Department of Dentistry, Kiran Hospital, Karachi, Pakistan.

*Corresponding Author:
Zareena Z. Jangda
BDS student, Civil hospital
University Road, 239-C
block 2, P.E.C.H.S
Karachi, Pakistan
Tel: +923332331234
E-mail: [email protected]

Received Date: June 25, 2016; Accepted Date: July 18, 2016; Published Date: July 26, 2016

Citation: Jangda ZZ, Maqsood A, Azam K (2016) Assessment of Head and Neck Cancer Patient’s Co-Morbidity in Accordance to the International Classification of Functioning, Disability and Health. J Interdiscipl Med Dent Sci 4:203. doi:10.4172/2376-032X.1000203

Copyright: © 2016 Jangda ZZ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Background: Head and neck cancers are the most common cancers in developing countries, especially in South Asia. The international classification of functioning, disability and health core set for head and neck cancers (ICF-HNC) covers the typical array of problems in functioning, in patients suffering from head and neck cancer.

Objectives: To assess the head and neck cancer patient’s co-morbidity using the ICF-HNC as a reference.

Methods: Cross sectional multi-centric study at three different hospitals in Karachi, Pakistan. Data collection included structured question and answer sessions that were carried out by a single researcher, according to the ICFHNC checklist.

Results: Of the 325 patients, 258 (about 80%) experienced complete problems related to mouth function. The study also demonstrated significant number of patients (187) who had problems related to activity and social functioning.

Conclusion: The ICF comprehensively address and structures head and neck cancer patient’s problems. Societal and kindred support may well be purposely incorporated in rehabilitation plan of HNC sufferers.

Abstract

Background: Head and neck cancers are the most common cancers in developing countries, especially in South Asia. The international classification of functioning, disability and health core set for head and neck cancers (ICF-HNC) covers the typical array of problems in functioning, in patients suffering from head and neck cancer.

Objectives: To assess the head and neck cancer patient’s co-morbidity using the ICF-HNC as a reference.

Methods: Cross sectional multi-centric study at three different hospitals in Karachi, Pakistan. Data collection included structured question and answer sessions that were carried out by a single researcher, according to the ICFHNC checklist.

Results: Of the 325 patients, 258 (about 80%) experienced complete problems related to mouth function. The study also demonstrated significant number of patients (187) who had problems related to activity and social functioning. Conclusion: The ICF comprehensively address and structures head and neck cancer patient’s problems. Societal and kindred support may well be purposely incorporated in rehabilitation plan of HNC sufferers.

Keywords

Disability; Functioning; Head and neck cancer; International Classification of functioning; Disability and health (ICFHNC); Patient perspective; Quality of life

Introduction

The head and neck cancers form the sixth most common cancer, globally [1-4]. Oral cancer has an impact on approximately 14.1 million people, making it one of the most pervasive cancers in the world [5,6]. The disease burden for oral cancer is much higher in South Asian countries when compared with developed countries [7,8]. Oral cancers are predominant forms of head and neck squamous cell cancer (HNSCC) in India, Pakistan, and other Southeast Asian countries; oropharyngeal and tongue cancers are common in the Western world [9,10]. The prevalence of oral cancer is increasing each year making it the most common in males and second most common cancer in females with a cumulative increase of 13,000 cases per year in Pakistan [11]. HNC form 21% of the cancers in males and 11% in females in Pakistan [12].

Head and neck cancers patients endure a vast array of disorders in body functions, for example, breathing and speaking, activity restrictions, like issues in communicating as well as limitations in their partaking in social life, for instance trouble getting back to work and living in the society. These patients often become unemployed as a result of their disease process, which adds financial burden to their already stressful lives.

In the past few years, the awareness and interest in the effect of cancer treatment on functioning of patients with head and neck cancer is growing. The assessment of functioning is multi-dimensional. In 2001, the world health organization (WHO) approved the International Classification of Functioning, Disability and Health (ICF). The ICF provides an internationally recognized nomenclature to classify disability and function related to biological, psychological and social viewpoint [13,14]. The international classification of Functioning, Disability and Health Core Set for Head and Neck Cancers (ICF-HNC) covers the typical spectrum of problems in head and neck cancer. The purpose of this study is to assess the head and neck cancer patient’s comorbidity using the ICF-HNC as guidance.

Methodology

All the data for our research was collected by a conducting a cross sectional, multi-centric study at three different study centers in Karachi, Pakistan. The three sites included the Civil Hospital, Jinnah Postgraduate Medical Centre and Kiran Hospital. Study duration was three months; from January-March (2016). The sample size is 325 which is calculated by openepi.com.

It was a human based study and the data collection included structured interviews carried by a single researcher keeping the extended ICF checklist as a guideline. The ICF head and neck checklist has a scale from 1 to 5 categorizing 1 as not impaired to 5 as completely impaired functioning.

Respondents’ inclusion criteria included patients with head and neck cancer who, from the time of diagnosis and any time thereafter, free from severe unstable psychiatric and/or mental conditions such as suicidal ideation, acute psychosis, or dementia. Exclusion criteria for this study included pregnant patients. And people who had cancers other than head and neck region.

SPSS version 16 was used for statistical analysis. Chi square fitness of good test was applied.

Ethics Consideration

Prior to the start of this research, approval was taken from the concerned authorities of the Civil Hospital, Jinnah Postgraduate Medical Centre and Kiran Hospital, Karachi, Pakistan. Before beginning with the collection of the data, all participants of this study were given a brief summary about the outlook of this research. An informed written consent was taken from the participants. They were also provided with assurance of discretion of their personal data as well as their shared information.

Results

Total 325 patients having head and neck cancer were included in this study, the frequencies and the valid percentages were calculated as descriptive statistics for all the questions (Tables 1 and 2). On the other hand we cumulated questions into categories and generated new overall variables. For the first eight questions that included questions regarding problem in biting, chewing, moving food around the mouth, saliva, swallowing, sucking, taste and mouth function a new variable overall mouth function was created. And same was done for the remaining questions. Overall voice function variable was customized for the next three questions. From questions twelve to twenty five overall structure of the mouth variable was created. Then modes were calculated for new generated variables maximum and minimum mode. Maximum mode was selected. The remaining statistical analysis was executed on calculated mode. Next we calculated their frequencies for the new variables and applied Chi square fitness of goodness test. The P value was set at less than 0.01 as statistically significant (Table 3).

Questions None Mild Moderate Severe Complete
Biting     3 (0.9%) 50 (15.4%) 272 (83.7%)
Chewing     53 (16.3%)   272 (83.7%)
Moving Food 14 (4.3%)   19 (5.8%) 50 (15.4%) 242 (74.5%)
Saliva 29 (8.9%)   245 (75.4%) 1 (0.3) 50 (15.4%)
Swallowing 64 (19.7%) 1 (0.3%) 40 (12.3%) 186 (57.2%) 34 (10.5%)
Sucking 64 (19.7%) 24 (7.4%) 62 (19.1%) 153 (47.1%) 22 (6.8%)
Taste 23 (7.1%) 164 (50.5%) 15 (4.6%) 16 (4.9%) 107 (32.9%)
overall MF   1 (0.3%) 297 (91.4%)   27 (8.3%)
Producing Sound 201 (61.8%) 32 (9.8%) 26 (8.0%) 22 (6.8%) 44 (13.5%)
Quality of Sound 64 (19.7%) 2 (0.6%) 194 (59.7%) 22 (6.8%) 43 (13.2%)
Voice Function 257 (79.1%) 1 (0.3%) 2 (0.6%) 22 (6.8%) 43 (13.2%)
Emotional Function 22 (6.8%) 38 (11.7%) 2 (0.6%) 186 (57.2%) 77 (23.7%)
Energy 22 (6.8%) 38 (11.7%) 153 (47.1%)   112 (34.5%)
Breathing 51 (15.7%) 50 (15.4%) 194 (59.7%) 17 (5.2%) 13 (4%)
Teeth 14 (4.3%) 51 (15.7%) 47 (14.5%) 213 (65.5%)  
Lips 14 (4.3%) 244 (75.1%) 51 (15.7%) 16 (4.9%)  
Tongue 30 (9.2%) 50 (15.4%) 72 (22.2%) 172 (52.9%) 1 (0.3%)
Roof of Mouth   50 (15.4%) 30 (9.2%) 209 (64.3%)  
Parts of Mouth 14 (4.3%) 82 (25.2%) 53 (16.3%) 175 (53.8%) 1 (0.3%)
St of mouth overall   14 (4.3%) 283 (87.1%)   28 (8.6%)
Throat 14 (4.3%)   67 (20.6%) 22 (6.8%) 222 (68.3%)
Voice Box 14 (4.3%)   50 (15.4%) 22 (6.8%) 239 (73.5%)
Head and Neck 152 (46.8%) 1 (0.3%) 89 (27.4%) 50 (15.4%) 33 (10.2%)
Shoulder 58 (17.8%) 82 (25.2%) 81 (24.9%) 51 (15.7%) 53 (16.3%)987
Pain 168 (51.7%) 94 (28.9%)   1 (0.3%) 62 (19.1%)
Speaking 80 (24.6%) 3 (0.9%)   208 (64%) 34 (10.5%)
Drinking 79 (24.3%) 4 (1.2%) 12 (3.7%) 213 (65.5%) 17 (5.2%)
Eating 2 (0.6%) 15 (4.6%) 50 (15.4%) 52 (16%) 206 (63.4%)
Daily Routine 22 (6.8%) 3 (0.9%) 243 (74.8%)   57 (17.5%)
Financial 8 (2.5%) 22 (6.8%) 179 (55.1%) 1 (0.3%) 115 (35.4%)
Family 232 (71.4%)   24 (7.4%)   69 (21.2%)
Intimate 250 (76.9%)   24 (7.4%) 50 (15.4%) 1 (0.3%)

Table 1: Descriptive statistics (I).

Questions Hindrance Help Neither
Family (help/hinderance) 144 (44.3%) 120 (36.9%) 61 (18.8%)
Professionals (help/hinderance)   271 (83.4%) 54 (16.6%)
Diet (help/hinderance)   101 (31.1%) 174 (53.5%)
Medicines (help/hinderance)   325 (100%)  

Table 2: Descriptive statistics (II).

Overall function None Mild Moderate Severe Complete p-value
Mouth function 14 (4.3%)   3 (0.9%) 50 (15.4%) 258 (79.4%) < 0.001**
Voice function 14 (4.3%) 51 (15.7%) 4 (1.2%) 229 (70.5%) 27 (8.3%) < 0.001**
Structure of Mouth 14 (4.3%)     72 (22.2%) 239 (73.5%) < 0.001**
Activity and Social functioning 36 (11.1%)   52 (16%) 187 (57.5%) 50 (15.4) < 0.001**

Table 3: Frequency distribution by Chi Square fitness of goodness test.

Most of the head and neck patients around 80% (258) experienced complete problem and 14 patients were living with mild trouble related to mouth function with a p-value of < 0.01 regarding voice function 229 patient felt severe problem p-value < 0.01. When the patients were asked about their overall structure of mouth, 239 out of 325 participants have complete problem regarding this. For the questions concerning the activity and social functioning, 187 felt severe problem, 50 with complete problem and 52 with moderate problem with a p-value < 0.01.

When these participants were asked about that living environment have either helped or hindered their progress, 43.3% experienced hindrance from family, but the health professionals have helped 83.4% of them. When they were enquired about food and diet 31.1% answered that diet have helped in their health progression. All of the participants responded that the medicine that were prescribed to them were very effective and they have helped them in improving their quality of life and health status.

Discussion

The International Classification of Functioning, Disability and Health designate human functioning in all characteristics including psychological and biosocial aspects of life [15]. The use of the ICF provides us the benefit of a thorough and inclusive evaluation of functioning and disability in patients with head and neck cancer. It acts as a reference framework which proves essential when communicating between health professionals and patients [16,17].

For the study, information was collected by asking the questions from patients and the health professional filling the questionnaire. In some other studies, the survey was based upon the response of physicians, physiotherapists, psychologists, and social workers dealing with head and neck cancer patients [18]. While our survey was solely based upon the response of patients.

In our study, the main areas of limitation in mouth functioning were related to biting (83.7%), chewing (83.7%), moving food around the mouth (74.5%). For the component of voice function (13.2%), majority of people had no major issues. The emotional function (23.7%) was affected in some of the patients. When considering the structure of mouth, the major parts affected were the throat (68.3%) and voice box (73.5%). Lastly looking at the aspect of activity and social functioning, the main complaint was about the issues in eating (63.4%).

Considering some other studies, it was mentioned that the patients were facing problem that were related to voice production, food intake and experiencing intense pain. When section of body functioning was considered the cancer survivors were confronting problem in speaking and socializing. Whereas, in social parameters eating and drinking were the main restrictions they were facing [19].

Furthermore, another significant and relevant area about which the patients were questioned about was whether their family, health professionals, diet and medicines were a help, hindrance or neither. Surprisingly for most of the patients, family support was not a feature and they considered them as a hindrance (44.3%), as a help (36.9%) and (18.8%) considered them to be neither a help nor a hindrance. As far as health professionals are considered, (83.4%) agreed that they were a help. Accessing the component of Diet, (53.5%) considered it to play no role while (31.1%) thought it helped. Lastly (100%) participants thought that the medicines were a help throughout.

The Comprehensive ICF-HNC defines; the most relevant aspects in the interdisciplinary upkeep of head and neck cancer patients. An exemption are the personal factors, which are not a part of the ICF classification so far, hence not in the ICF-HNC. Even though they are significantly important for practitioners [20]. Nevertheless, The ICF core sets help to comprehensively address and structure patients’ problems. This may be substantially useful during medical training but may also be of prime value in the hands of experienced clinicians, since physicians may underestimate patients’ functional problems [21].

Significant consideration should be given to prevention of head and neck cancer, by spreading awareness and educating the general public about the risk factors especially tobacco in any form (smoke or smokeless form). Early diagnosis or identification of pre-malignant lesions would also help in limiting the disease occurrence and its complications.

Conclusion

The international classification of functioning, disability and health chiefly identifies the problems which a head and cancer patient is going in their life span, first and foremost. The importance of family and social support is particularly highlighted in the results. It is principally suggested that a keen interpersonal interest from the fellow members of patients should be given an immense consideration in rehabilitation of HNC.

Competing Interests

The authors declare that they have no competing interests

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