Laryngorhinootologie 2013; 92(05): 314-325
DOI: 10.1055/s-0032-1333235
Originalie
© Georg Thieme Verlag KG Stuttgart · New York

Entwicklung eines ICF-basierten Leitfadens für die Beurteilung funktioneller Aspekte bei Kopf-Hals-Tumoren

Development of an ICF-based Clinical Practice Guideline for the Assessment of Function in Head and Neck Cancer
U. Tschiesner
1   Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum der Universität München, München
,
M. Stier-Jarmer
1   Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum der Universität München, München
2   Lehrstuhl für Public Health und Versorgungsforschung – IBE, Ludwig-­Maximilians-Universität, München
,
S. Strieth
3   Klinik für Hals-Nasen-Ohrenheilkunde, Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main
,
S. Singer
4   Institut für Medizinische Biometrie, Epidemiologie und Informatik, ­Universitätsmedizin der Johannes Gutenberg-Universität, Mainz
,
A. Dietz
5   Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig, Leipzig
,
R. Fietkau
6   Strahlenklinik, Universitätsklinikum Erlangen, Erlangen
,
B. Wollenberg
7   Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, ­Universitätsklinikum Schleswig-Holstein, Lübeck
,
G. Mast
8   Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum der Universität München, München
,
A. Cieza
2   Lehrstuhl für Public Health und Versorgungsforschung – IBE, Ludwig-­Maximilians-Universität, München
9   Faculty of Social and Human Sciences, School of Psychology, University of Southampton, UK
,
U. A. Harréus
1   Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Klinikum der Universität München, München
› Author Affiliations
Further Information

Publication History

eingereicht14 November 2012

akzeptiert 16 December 2012

Publication Date:
30 January 2013 (online)

Zusammenfassung

Hintergrund:

Funktionelle Beeinträchtigungen bei Kopf-Hals-Tumoren werden bisher im klinischen Alltag selten standardisiert erhoben. Klinische Studien mit der Zielgröße Funktionserhalt bei KHT verwenden viele verschiedene Instrumente. Die Ergebnisse sind deshalb oft schlecht vergleichbar und lassen zu wenig klinische Schlussfolgerungen zu. Es war daher notwendig und Ziel dieser Studie, die nach bisheriger Evidenz und interdisziplinärem Expertenkonsens am besten geeigneten Instrumente zur Beurteilung von Funktionsfähigkeit bei KHT zu identifizieren und Empfehlungen für deren Verwendung in einem Leitfaden zusammenzustellen.

Material:

In Vorstudien wurde unter Verwendung festgelegter Kriterien eine Vorauswahl an Instrumenten getroffen. Teilnehmer einer interdisziplinären Konsensuskonferenz bewerteten die Instrumente und stimmten ab, welche Instrumente empfohlen werden für die Anwendungsbereiche: Screening, Therapiebeurteilung und klinische Studien. Beteiligte Berufsgruppen waren HNO-Ärzte, Radioonkologen, Mund-Kiefer-Gesichtschirurgen, internistische Onkologen, Phoniater, Logopäden, Psychologen, Physiotherapeuten und Sozialarbeiter.

Ergebnisse:

98 Instrumente wurden auf der Konsensuskonferenz detailliert bewertet. 21 Teilnehmer empfahlen daraus für die 3 Anwendungsbereiche jeweils Instrumente zur Beurteilung von 6 Funktionsbereichen: Therapiekon­trolle – Schmerz – Nahrungsaufnahme – Stimme, Sprechen, Atmung – weitere organische Probleme – Psychosoziale Funktion.

Schlussfolgerung:

Es wurden Instrumente ausgewählt, interdisziplinär bewertet und für die Anwendung im klinischen Alltag und in klinischen Studien empfohlen. Damit steht ein Tool zur schnellen, umfassenden funktionellen Beurteilung von Patienten mit KHT zur Verfügung, das nun implementiert und auf seine Praxistauglichkeit getestet werden kann.

Abstract

Development of an ICF-based Clinical Practice Guideline for the Assessment of Function in Head and Neck Cancer

Background:

Functional outcome following head and neck cancer is not regularly assessed in a standardized way in clinical practice. Clinical trials assessing functional outcome apply many different instruments. Therefore, results are not always comparable and have limited clinical implications. Aim of this study was the identification, interdisciplinary evaluation, and recommendation of functional outcome instruments for use in clinical practice and clinical trials in patients with HNC.

Material:

Preparatory studies came up with a shortlist of outcome instruments on the basis of previously determined criteria. An interdisciplinary expert group evaluated these instruments and decided on which ones can be recommended for use in 3 application areas: screening, therapy evaluation/planning, and clinical trials. Decision making health professionals included physicians (ENT and maxillofacial surgeons, radiotherapists, oncologists), medical psychologists, speech and language therapists, physiotherapists, and social workers.

Results:

98 instruments were presented at the consensus conference. Altogether 21 participants recommended for each of the 3 application areas a basic set of measures for the evaluation of impairment in 6 functional domains: follow-up therapy monitoring, pain, ingestion, voice/speaking, other organic problems, and psychosocial problems.

Conclusion:

A multi-professional expert’s pool discussed and adopted recommendations for the use of functional outcome ins­truments in clinical praxis and/or in research. The re­commended instruments are now available for use in clinical routine.·

 
  • Literatur

  • 1 Robert Koch-Institut (RKI) . Beiträge zur Gesundheitsberichterstattung des Bundes. Krebs in Deutschland 2005/2006 Häufigkeiten und Trends (Eine gemeinsame Veröffentlichung des Robert Koch-Instituts und der Gesellschaft der epidemiologischen Krebsregister in Deutschland e. V.). 7. Ausgabe Robert Koch-Institut; Berlin: 2010
  • 2 Bjordal K, Ahlner-Elmqvist M, Hammerlid E, Boysen M, Evensen JF, Biörklund A, Jannert M, Westin T, Kaasa St. A Prospective Study of Quality of Life in Head and Neck Cancer Patients. Part II: Longitudinal Data. Laryngoscope 2001; 111: 1440-1452
  • 3 Dietz A, Meyer A, Singer S. Lebensqualitätsmessungen bei Patienten mit Kopf-Hals-Malignomen. HNO 2009; 57: 857-865
  • 4 Denis F, Garaud P, Bardet E, Alfonsi M, Sire C, Germain T, Bergerot P, Rhein B, Tortochaux J, Oudinot P, Calais G. Late toxicity results of the Gortec 94-01 randomized trial comparing radiotherapy with concomitant radiochemotherapy for advanced-stage oropharynx carcinoma: Comparison of LENT/SOMA, RTOG/EORTC, and NCI-CTC Scoring Systems. Int J Radiat Oncol Biol Phys 2003; 55: 93-98
  • 5 Rogers SN, Scott J, Chakrabati A, Lowe D. The patients’ account of outcome following primary surgery for oral and oropharyngeal cancer using a ‘quality of life’ questionnaire. Eur J Cancer Care 2008; 17: 182-188
  • 6 Vilaseca I, Chen AY, Backscheider AG. Long-term quality of life after total laryngectomy. Head Neck 2006; 28: 313-320
  • 7 Millsopp L, Brandom L, Humphris G, Lowe D, Rogers S. Facial appearance after operations for oral and oropharyngeal cancer: a comparison of casenotes and patientcompleted questionnaire. Br J Oral Maxillofac Surg 2006; 44: 358-363
  • 8 Langmore SE, Krisciunas GP. Dysphagia after radiotherapy for head and neck cancer: etiology, clinical presentation and efficacy of current treatments. Perspectives on Swallowing & Swallowing Disorders (Dysphagia) 2010; 19: 32-38
  • 9 Dietzsch S, Melzer R, Boehm A, Wolf U, Kortmann RD, Fuchs M. Schluckstörungen nach Kopf-Hals-Tumortherapie und die Möglichkeiten der IMRT. Laryngo-Rhino-Otol 2011; 90: 657-662
  • 10 Vissink A, Mitchell JB, Baum BJ, Limesand KH, Jensen SB, Fox PC, Elting LS, Langendijk JA, Coppes RP, Reyland ME. Clinical management of salivary gland hypofunction and xerostomia in head-and-neck cancer patients: successes and barriers. Int J Radiation Oncology Biol Phys 2010; 78: 983-991
  • 11 Singer S, Danker H, Dietz A, Homemann B, Koscielny S, Oeken J, Matthäus C, Vogel H-J, Krauß O. Screening for mental disorders in laryngeal cancer patients: a comparison of 6 methods. Psycho-Oncology 2008; 17: 280-286
  • 12 Verdonck-de Leeuw IM, van Bleek WJ, Leemans CR, de Bree R. Employment and return to work in head and neck cancer survivors. Oral Oncol 2010; 46: 56-60
  • 13 Rogers SN, Harvey-Woodworth CN, Hare J, Leong P, Lowe D. Patients’ perception of the financial impact of head and neck cancer and the relationship to health related quality of life. Brit J Oral Max Surg 2012; 50: 410-416
  • 14 Abendstein H, Nordgren M, Boysen M, Jannert M, Silander E, Ahlner-Elmqvist M, Hammerlid E, Bjordal K. Quality of Life and Head and Neck Cancer: A 5 Year Prospective Study. Laryngoscope 2005; 115: 2183-2192
  • 15 Chaplin JM, Morton RP. A prospective, longitudinal study of pain in head and neck cancer patients. Head Neck 1999; 21: 531-537
  • 16 Langendijk JA, Doornaert P, Verdonck-de Leeuw IM, Leemans CR, Aaronson NK, Slotman BJ. Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol 2008; 26: 3770-3776
  • 17 Raber-Durlacher JE, Brennan MT, Verdonck-de Leeuw IM, Gibson RJ, Eilers JG, Waltimo T, Bots CP, Michelet M, Sollecito TP, Rouleau TS, Sewnaik A, Bensadoun RJ, Fliedner MC, Silverman S, Spijkervet FKL. Swallowing dysfunction in cancer patients. Support Care Cancer 2012; 20: 433-443
  • 18 Hassan SJ, Weymuller EA. Assessment of quality of life in head and neck cancer patients. Head Neck 1993; 15: 485-496
  • 19 Lefebvre JL. Laryngeal preservation in head and neck cancer: multidisciplinary approach. Lancet Oncol 2006; 7: 747-755
  • 20 Kutter J, Lang F, Monnier P, Pasche P. Transoral laser surgery for pharyngeal and pharyngolaryngeal carcinomas. Arch Otolaryngol Head Neck Surg 2007; 133: 139-144
  • 21 Karatzanis AD, Psychogios G, Zenk J, Waldfahrer F, Hornung J, Velegrakis GA, Iro H. Evaluation of available surgical management options for early supraglottic cancer. Head Neck 2010; 32: 1048-1055
  • 22 Bozec A, Poissonnet G, Chamorey E, Casanova C, Laout C, Vallicioni J. Quality of life after oral and oropharyngeal reconstruction with a radial forearm free flap: prospective study. J Otolaryngol Head Neck Surg 2009; 38: 401-408
  • 23 Sharp D, Theile D, Cook R, Coman W. Long-term functional speech and swallowing outcomes following pharyngolaryngectomy with free jejunal flap reconstruction. Ann Plast Surg 2010; 64: 743-746
  • 24 Scott-Brown M, Miah A, Harrington K, Nutting C. Evidence-based review: Quality of life following head and neck intensity-modulated radiotherapy. Radiother Oncol 2010; 97: 249-257
  • 25 Roe JW, Carding PN, Dwivedi RC, Kazi RA, Rhys-Evans PH, Harrington KJ, Nutting CM. Swallowing outcomes following Intensity Modulated Radiation Therapy (IMRT) for head & neck cancer – a systematic review. Oral Oncol 2010; 46: 727-733
  • 26 Nuttin CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, Clark C, Miles EA, Miah AB, Newbold K, Tanay M, Adab F, Jefferies SJ, Scrase C, Yap BK, Ahern RP, Sydenham MA, Emson M, Hall E. PARSPORT trial management group . Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol 2011; 12: 127-136
  • 27 Rogers SN, Ahad SA, Murphy AP. A structured review and theme analysis of papers published on ‘quality of life’ in head and neck cancer: 2000-2005. Oral Oncol 2007; 43: 843-868
  • 28 Kanatas AN, Rogers SN. A systematic review of patient self-completed questionnaires suitable for oral and maxillofacial surgery. Brit J Oral Max Surg 2010; 48: 579-590
  • 29 Tschiesner U, Rogers SN, Harreus U, Berghaus A, Cieza A. Comparison of outcome measures in head and neck cancer: a literature review 2000–2006. Head Neck 2009; 31: 251-259
  • 30 Kreeft AM, van der Molen L, Hilgers FJ, Balm AJ. Speech and swallowing after surgical treatment of advanced oral and oropharyngeal carcinoma: a systematic review of the literature. Eur Arch Otorhinolaryngol 2009; 266: 1687-1698
  • 31 Paleri V, Thomas L, Basavaiah N, Drinnan M, Mehanna H, Jones T. Oncologic outcomes of open conservation laryngectomy for radiorecurrent laryngeal carcinoma: a systematic review and meta-analysis of English-language literature. Cancer 2011; 117: 2668-2676
  • 32 Mehanna HM, Morton RP. Why are head and neck cancer clinicians not measuring quality of life?. J Laryngol Otol 2006; 120: 861-864
  • 33 Kanatas AN, Mehanna HM, Lowe D, Rogers SN. A second national survey of health-related quality of life questionnaires in head and neck oncology. Ann R Coll Surg Engl 2009; 91: 420-425
  • 34 Snyder CF, Blackford AL, Brahmer JR, Carducci MA, Pili R, Stearns V, Wolff AC, Dy SM, Wu AW. Needs assessment can identify scores on HRQOL questionnaires that represent problems for patients: an illustration with the Supportive Care Needs Survey and the QLQ-C30. Qual Life Res 2010; 19: 837-845
  • 35 Wright EP, Selby PJ, Crawford M, Gillibrand A, Johnston C, Perren TJ, Rush R, Smith A, Velikova G, Watson K, Gould A, Cull A. Feasibility and Compliance of Automated Measurement of Quality of Life in Oncology Practice. J Clin Oncol 2003; 21: 374-382
  • 36 World Health Organization . International Classification of Functioning, Disability and Health: ICF. Geneva: WHO; 2001
  • 37 Tschiesner U, Rogers SN, Dietz A, Yueh B, Cieza A. Development of ICF Core Sets for head and neck cancer. Head Neck 2010; 32: 210-220
  • 38 Tschiesner U, Linseisen E, Becker S, Mast G, Rogers SN, Walvekar RR, Berghaus A, Cieza A. Content validation of the International Classification of Functioning, disability and health core sets for head and neck cancer: a multicentre study. J Otolaryngol Head Neck Surg 2010; 39: 674-687
  • 39 Tschiesner U, Cieza A, Rogers SN, Piccirillo J, Funk G, Stucki G, Berghaus A. Developing core sets for patients with head and neck cancer based on the International Classification of Functioning, Disability and Health (ICF). Eur Arch Oto-Rhino-L 2007; 264: 1215-1222
  • 40 Kirschneck M, Sabariego C, Singer S, Tschiesner U (in revision). Assessment of functional outcomes in head and neck cancer patients according to the ICF Core Sets from the perspective of the multi-professional team – Results of four Delphi surveys. Head Neck; in revision since Oct. 28th 2012
  • 41 Stier-Jarmer M, Sabariego C, Cieza A, Harreus U, Tschiesner U (in preparation). Assessment of functional outcomes in head and neck cancer – a systematic literature review. planned submission to Archives of Otolaryngology
  • 42 Linstone HA, Turoff M. Introduction to the Delphi method: techniques and applications. In: Linstone HA, Turoff M. (eds.). The Delphi method: techniques and applications. Reading/MA: Addison-Wesley; 1975: 3-12
  • 43 Hassion F, Keeney S. Research guidelines for the Delphi survey technique. J Adv Nurs 2000; 4: 1008-1015
  • 44 Wuyts FL, De Bodt MS, Molenberghs G, Remacle M, Heylen L, Millet B, Van Lierde K, Raes J, Van de Heyning PH. The Dysphonia Severity Index: An objective measure of vocal quality based on a multiparameter approach. J Speech Lang Hear Res 2000; 43: 796-809
  • 45 Nawka T, Franke I, Galkin E. Objektive Messverfahren in der Stimmdiagnostik. Forum Logopädie 2006; 4: 14-21
  • 46 Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, Leonard RJ. Validity and Reliability of the Eating Assessment Tool (EAT-10). Ann Oto Rhinol Laryn 2008; 117: 919-924
  • 47 Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN Guidelines for Nutrition Screening 2002. Clin Nutr 2003; 22: 415-421
  • 48 Prosiegel M, Heintze M, Wagner-Sonntag E, Hannig C, Wuttge-Hannig A, Yassouridis A. Schluckstörungen bei neurologischen Patienten: Eine prospektive Studie zu Diagnostik, Störungsmustern, Therapie und Outcome. Nervenarzt 2002; 73: 364-370
  • 49 Kroenke K, Spitzer RL, Williams JBW, Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007; 146: 317-325
  • 50 Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. Validity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606-613
  • 51 Gräfe K, Zipfel S, Herzog W, Löwe B. Screening psychischer Störungen mit dem „Gesundheitsfragebogen für Patienten (PHQ-D)“. Ergebnisse der deutschen Validierungsstudie. Diagnostica 2004; 50: 171-181
  • 52 Folstein MF, Folstein SE, Mchugh PR. Mini-Mental State (a practical method for grading the state of patients for the clinician). J Psychiatr Res 1975; 12: 189-198
  • 53 Deutsche Vereinigung für Sozialarbeit im Gesundheitswesen e.V. (DVSG) Social Score – Langfassung Version 1.0 2011 – unveröffentlichtes Instrument
  • 54 Aaronson Nk, Ahmedzai S, Bergman B, Bullinger M, Cull A, Nj Duez, Filiberti A, Flechtner H, Fleishman Sb, Jcjm DS, Klee M, Osoba D, Razavi D, Rofe Pb, Schraub S, Sneeuw K, Sullivan M, Takeda F. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365-376
  • 55 Jensen MP, Karoly P, Braver S. The measurement of clinical pain intensity – A comparison of 6 methods. Pain 1986; 27: 117-126
  • 56 Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0; Published: May 28, 2009 (v4.03: June 14, 2010)
  • 57 Oken MM, Creech RH, Tormey DC, Horton J, Davis TE, McFadden ET, Carbone PP. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649-655
  • 58 Bartolome G, Schröter-Morasch H Hrsg Schluckstörungen Diagnostik und Rehabilitation. 3. Auflage München, Jena: Urban & Fischer Verlag; 2006
  • 59 Rosenbek JC, Robbins JA, Roecker EB, Coyle JL, Wood JL. A penetration-aspiration scale. Dysphagia 1996; 11: 93-98
  • 60 Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67: 361-370
  • 61 Herrmann C, Buss U, Snaith RP. HADS-D: Hospital Anxiety and Depression Scale – Deutsche Version; Ein Fragebogen zur Erfassung von Angst und Depressivitäit in der somatischen Medizin. Bern: Verlag Hans Huber; 1995
  • 62 Wittchen HU, Beloch E, Garczynski E, Holly A, Lachner G, Perkonigg A, Pfütze EM, Schuster P, Vodermaier A, Vossen A, Wunderlich U, Zieglngsberger S. Münchener Composite International Diagnostic Interview (M-CIDI). Max Planck Institut für Psychiatrie, München: Eigendruck; 1995
  • 63 Friedrich & Dejonckere. Das Stimmdiagnostik – Protokoll der European Laryngological Society (ELS) – erste Erfahrungen im Rahmen einer Multizenterstudie. Laryngo − Rhino − Otol 2005; 84: 744-752
  • 64 Jacobson BH, Johnson A, Grywalski C et al. The Voice Handicap Index (VHI): Development and validation. Am J Speech Lang Pathol 1997; 6: 66-70
  • 65 Nawka T, Wiesmann U, Gonnermann U. Validierung des Voice Handicap Index (VHI) in der deutschen Fassung. HNO 2003; 51: 921-929
  • 66 Rosen CA, Lee AS, Osborne J, Zullo T, Murry T. Development and validation of the voice handicap index-10. Laryngoscope 2004; 114: 1549-1556
  • 67 Bjordal K, Ahlner-Elmqvist M, Tollesson E, Jensen AB, Razavi D, Maher EJ, Kaasa S. Development of a European Organization for Research and Treatment of Cancer (EORTC) questionnaire module to be used in quality of life assessments in head and neck cancer patients. EORTC Quality of Life Study Group. Acta Oncol 1994; 33: 879-885
  • 68 Bjordal K, Hammerlid E, Ahlner-Elmqvist M, de Graeff A, Boysen M, Evensen JF, Biorklund A, de Leeuw JRJ, Fayers PM, Jannert M, Westin T, Kaasa S. Quality of life in head and neck cancer patients: validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35. J Clin Oncol 1999; 17: 1008-1019
  • 69 Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin J, Goepfert H. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg 2001; 127: 870-876
  • 70 Bauer F. Schluckbezogene Lebensqualität bei Mundhöhlenkarzinomen, Anderson-Dysphagia-Inventory, deutsche Version. HNO 2010; 58: 692-697
  • 71 Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care. Geneva, Switzerland: World Health Organization; 2001
  • 72 Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerström Test for Nicotine Dependence: A revision of the Fagerström Tolerance Questionnaire. Brit J Addict 1991; 86: 1119-1127
  • 73 Schumann A, Rumpf HJ, Meyer C, Hapke U, John U. Deutsche Version des Fagerström-Test for Nicotine Dependence (FTND-G) und des Heaviness of Smoking Index (HSI-G). In: Glöckner-Rist A, Rist F, Küfner H. Hrsg Elektronisches Handbuch zu Erhebungsinstrumenten im Suchtbereich (EHES). Version 3.00. Mannheim: Zentrum für Umfragen, Methoden und Analysen; 2003
  • 74 Late Effects of Normal Tissues (LENT) Consensus Conference . Lent soma scales for all anatomic sites. Int J Radiat Oncol 1995; 31: 1049-1091
  • 75 Sneeuw KC, Aaronson NK, Sprangers MA, Detmar SB, Wever LD, Schornagel JH. Comparison of patient and proxy EORTC QLQ-C30 ratings in assessing the quality of life of cancer patients. J Clin Epidemiol 1998; 51: 617-631
  • 76 Mehanna HM, Morton RP. Patients’ views on the utility of quality of life questionnaires in head and neck cancer: a randomised trial. Clin Otolaryngol 2006; 31: 310-316
  • 77 Snyder CF, Dy SM, Hendricks DE, Brahmer JR, Carducci MA, Wolff AC, Wu AW. Asking the right questions: investigating needs assessments and health-related quality-of-life questionnaires for use in oncology clinical practice. Support Care Cancer 2007; 15: 1075-1085
  • 78 Donaldson M. Using patient-reported outcomes in clinical oncology practice: benefits, challenges and next steps. Expert Review of Pharmacoeconomics & Outcomes Research 2006; 6: 87-95
  • 79 Velikova G, Booth L, Smith AB, Brown PM, Lynch P, Brown JM, Selby PJ. Measuring quality of life in routine oncology practice improves communication and patient well-being: a randomized controlled trial. J Clin Oncol 2004; 22: 714-724
  • 80 Verdonck-de Leeuw IM, Debree R, Keizer AL, Houffelaar T, Cuijpers P, Vanderlinden MH, Leemans CR. Computerized prospective screening for high levels of emotional distress in head and neck cancer patients and referral rate to psychosocial care. Oral Oncol 2009; 45: e129-e133
  • 81 Friedland PL, Bozic B, Dewar J, Kuan R, Meyer C, Phillips M. Impact of multidisciplinary team management in head and neck cancer patients. Br J Cancer 2011; 104: 1246-1248