Seeking a quality life after head or neck cancer (Fall, 2009)

September 14, 2009

Dr. Andrew Olshan

Throughout his two decades of studying head and neck cancers, Andrew Olshan, PhD, has uncovered information that has helped physicians treat and possibly prevent the disease.

Treatments for these cancers can dramatically affect function and put patients in the distressing position of learning to talk, eat, swallow or even breathe in new ways. In addition to the physical struggle, many patients must navigate a swath of psychological, social, emotional and employment challenges.

That, says Olshan, is why understanding cause and prevention is critical.

Olshan leads the Carolina Head and Neck Cancer Study (CHANCE), funded by the National Cancer Institute. The study, being conducted in 46 counties in central and eastern North Carolina, has accrued data from nearly 1,400 cases of head and neck cancer to date, making it the largest study of head and neck cancer ever conducted in the U.S.

So far, it has confirmed not only that people who smoke tobacco and/or drink alcohol are more likely than others to develop head and neck cancer, but also that the risk from smoking and drinking appears to be higher for African-Americans. These are critical links to understanding ways to prevent the disease.

Now, with a grant from LIVESTRONG, TM Olshan and his team already are building on the CHANCE study and discovering more about how treatments might affect patients’ overall quality of life.

“By studying the experiences of head and neck cancer survivors, we hope to help health professionals effectively manage the impact of treatment on a patient’s social, family and work roles,” says Olshan, chair of the Department of Epidemiology in the UNC Gillings School of Global Public Health and research professor, Department of Otolaryngology/Head and Neck Surgery, UNC School of Medicine.

This new study — in its fourth and final year of enrolling patients — zeroes in on the experiences of African-American survivors, to see whether factors influencing their quality of life are different from those of white survivors.

“This study focuses on an under-investigated aspect of health disparities in North Carolina,” Olshan says. “Do African Americans surviving with this cancer have a different experience than white patients? If so, what are the reasons?”

The information can be valuable to surgeons, including Mark C. Weissler, MD, J.P. Riddle Distinguished Professor of Otolaryngology- Head and Neck Surgery at UNC, who collaborates with Olshan.

“In this era of evidence-based medicine and comparative effectiveness research, studies such as this are necessary to ferret out what are really the best treatment strategies,” Dr. Weissler says. “Strategies may differ between different patient populations, and that is important to know.”

Head and neck cancer includes oral, pharyngeal, and laryngeal cancer — cancers of the mouth, tongue, throat and other sites. More than 48,000 Americans will develop cancer of the head and neck in 2009, and nearly 11,260 will die from it, according to the American Cancer Society. The cancer strikes blacks more often than whites, and survival rates are notably poorer for blacks than whites.

For the LIVESTRONG project, researchers are interviewing head and neck cancer survivors one year and three years after their diagnosis, using interview instruments designed specifically to gauge their quality of life from several aspects: physical, social/family, emotional and functional well-being.

“If we can identify any disparities and determine strong predictors, then greater attention can be given to recognizing these factors, and people who treat cancer can take them into account when considering a patient’s treatment course and quality of life afterward,” Olshan says.

For more information, visit:

The American Academy of O tolaryngology-Head and Neck Surgery: www.entnet.org

National Cancer Institute, US National Institutes of Health:
www.cancer.gov/cancertopics/types/head-and-neck

American Cancer Society: www.cancer.org

— Kim Gazella

Carolina Public Health is a publication of the University of North Carolina at Chapel Hill Gillings School of Global Public Health. To view previous issues, please visit www.sph.unc.edu/cph.