Treating radiation-induced trismus in head and neck cancer

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Paper I Paper II Paper III Paper IV No. of patients n= 75 n= 100 n= 50 n= 216 Female 30 38 19 62 Male 45 62 31 154 Age (mean) 62 58 58 60 Tumour localisation Salivary gland 10 - - - Oral cavity 22 2 1 28 Oropharynx 29 76 38 144 Tumor colli 6 12 6 22 Nasopharynx 5 10 5 17 Other 3 - - 5 Treatment regimen Radiotherapy 17 15 7 63 Surgery 8 0 0 0 Surgery + Radiotherapy

15 8 4 N/A

Radiochemotherapy 29 77 39 153 Surgery+ Radiochemotherapy

6 0 0 N/A

Stage classification I 9 1 1 8 II 20 12 8 40 III 16 20 8 44 IV 29 55 27 123 Missing 1 12 6 1

Table 5. Patient characteristics. Abbreviations: N/A=Not applicable.

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Göteborg Trismus Questionnaire (GTQ) vers 1.8. Used by permission © Finizia, Rydén, Fagerberg-Mohlin & Edström Sahlgrenska Academy, Göteborg University, Sweden + +

Göteborg Trismus Questionnaire (GTQ) Detta formulär innehåller frågor i samband med gapsvårigheter och käkbesvär. Besvara frågorna genom att markera det svarsalternativ du tycker stämmer bäst. Om du är osäker, markera det alternativ som känns riktigast. Har Du under den senaste veckan haft:

Inte alls Lite Måttligt Mycket Väldigt mycket

1 2 3 4 5

1. trötthets/stelhetskänslor i käkarna

2. smärtor eller värk i ansikte och käkar

3. smärtor vid rörelse av käken (gapning/tuggning)

4. problem med att gapa stort eller bita över stor tugga

5. värk eller ömhet i käkmuskler

6. problem med att gäspa

7. käkledsljud

I vilken utsträckning begränsas eller omöjliggörs följande aktivitet av Dina käkbesvär?

1 2 3 4 5

8. äta hård föda

9. föra in mat i munnen

10. äta mjuk föda

11. bita av

Brukar Du:

1 2 3 4 5

12. bita ihop hårt

13. pressa med tungan

Göteborg Trismus Questionnaire (GTQ) vers 1.8. Used by permission © Finizia, Rydén, Fagerberg-Mohlin & Edström Sahlgrenska Academy, Göteborg University, Sweden + +

14. Hur mycket ansiktssmärta har Du just nu?

Har inte ansikts-smärta

Mycket lätt Lätt Måttlig Svår Mycket

svår Outhärdlig

1 2 3 4 5 6 7

15. Hur intensiv har smärtan varit när den var som värst den senaste månaden?

Har inte haft

ansikts-smärta

Mycket lätt Lätt Måttlig Svår Mycket

svår Outhärdlig

1 2 3 4 5 6 7

16. Hur intensiv har smärtan varit i genomsnitt den senaste månaden?

Har inte haft

ansikts-smärta

Mycket lätt Lätt Måttlig Svår

Mycket svår Outhärdlig

1 2 3 4 5 6 7

17. Har ansiktssmärtan stört Din förmåga att delta i sociala, fritids- och familjeaktiviteter den senaste månaden?

Har inte haft ansiktssmärta

1 2 3 4 5 0

18. Har ansiktssmärtan förändrat Din förmåga att arbeta (innefattar både förvärvsarbete och hushållssysslor) den senaste månaden?

Har inte haft ansiktssmärta

1 2 3 4 5 0

19. Hur begränsad är Din förmåga att gapa nu?

1 2 3 4 5

Sahlgrenska Academy, Göteborg University, Sweden

20. Har Din begränsade gapförmåga stört Din förmåga att delta i sociala, fritids- och familjeaktiviteter den senaste månaden?

Inte alls Lite Måttligt Mycket Väldigt

mycket

Har inte haft begränsad

gapförmåga

1 2 3 4 5 0

21. Har Din begränsade gapförmåga förändrat Din förmåga att arbeta (innefattar både förvärvsarbete och hushållssysslor) den senaste månaden?

Inte alls Lite Måttligt Mycket Väldigt

mycket

Har inte haft begränsad

gapförmåga

1 2 3 4 5 0

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!*+,-.!/0/1.23!4%&!*+,-.!/0/156!27!! !

EORTC QLQ C30 (version 3.0.) Vi är intresserade av några saker som har med Dig och Din hälsa att göra. Besvara alla frågor genom att sätta en ring runt den siffra som stämmer bäst in på Dig. Det finns inga svar som är "rätt" eller 'fel'. Den information Du lämnar kommer att hållas strikt konfidentiell. Inte En hel alls Lite del Mycket 1. Har Du svårt att göra ansträngande saker, 1 2 3 4 som att bära en tung kasse eller väska ?

2. Har Du svårt att ta en lång promenad ? 1 2 3 4

3. Har Du svårt att ta en kort promenad utomhus ? 1 2 3 4

4. Måste Du sitta eller ligga på dagarna ? 1 2 3 4

5. Behöver Du hjälp med att äta, klä Dig, tvätta Dig 1 2 3 4 eller gå på toaletten ? Under veckan som gått: Inte En hel alls Lite del Mycket 6. Har Du varit begränsad i Dina möjligheter att utföra antingen Ditt förvärvsarbete eller andra dagliga aktiviteter ? 1 2 3 4 7. Har Du varit begränsad i Dina möjligheter att utöva Dina hobbies eller andra 1 2 3 4 fritidssysselsättningar ?

8. Har Du blivit andfådd ? 1 2 3 4

9. Har Du haft ont ? 1 2 3 4

10. Har Du behövt vila ? 1 2 3 4

11. Har Du haft svårt att sova ? 1 2 3 4

12. Har Du känt dig svag ? 1 2 3 4

13. Har Du haft dålig aptit ? 1 2 3 4

14. Har Du känt dig illamående ? 1 2 3 4

15. Har Du kräkts ? 1 2 3 4

16. Har Du varit förstoppad ? 1 2 3 4

Fortsätt på nästa sida

Under veckan som gått: Inte En hel alls Lite del Mycket 17. Har Du haft diarré ? 1 2 3 4

18. Har Du varit trött ? 1 2 3 4

19. Har Dina dagliga aktiviteter påverkats av smärta ? 1 2 3 4

20. Har Du haft svårt att koncentrera Dig, t.ex. 1 2 3 4 läsa tidningen eller se på TV ? 21. Har Du känt Dig spänd ? 1 2 3 4

22. Har Du oroat Dig ? 1 2 3 4

23. Har Du känt Dig irriterad ? 1 2 3 4

24. Har Du känt Dig nedstämd ? 1 2 3 4

25. Har Du haft svårt att komma ihåg saker ? 1 2 3 4

26. Har Ditt fysiska tillstånd eller den medicinska behandlingen stört Ditt familjeliv ? 1 2 3 4 27. Har Ditt fysiska tillstånd eller den medicinska behandlingen stört Dina sociala aktiviteter ? 1 2 3 4 28. Har Ditt fysiska tillstånd eller den medicinska behandlingen gjort att Du fått ekonomiska ? 1 2 3 4 svårigheter ?

Sätt en ring runt den siffra mellan 1 och 7 som stämmer bäst in på Dig för följande frågor: 29. Hur skulle Du vilja beskriva Din hälsa totalt sett under den vecka som gått ? 1 2 3 4 5 6 7

Mycket dålig Utmärkt

30. Hur skulle Du vilja beskriva Din totala livskvalitet under den vecka som gått ? 1 2 3 4 5 6 7

EORTC QLQ C30 (version 3.0.) Vi är intresserade av några saker som har med Dig och Din hälsa att göra. Besvara alla frågor genom att sätta en ring runt den siffra som stämmer bäst in på Dig. Det finns inga svar som är "rätt" eller 'fel'. Den information Du lämnar kommer att hållas strikt konfidentiell. Inte En hel alls Lite del Mycket 1. Har Du svårt att göra ansträngande saker, 1 2 3 4 som att bära en tung kasse eller väska ?

2. Har Du svårt att ta en lång promenad ? 1 2 3 4

3. Har Du svårt att ta en kort promenad utomhus ? 1 2 3 4

4. Måste Du sitta eller ligga på dagarna ? 1 2 3 4

5. Behöver Du hjälp med att äta, klä Dig, tvätta Dig 1 2 3 4 eller gå på toaletten ? Under veckan som gått: Inte En hel alls Lite del Mycket 6. Har Du varit begränsad i Dina möjligheter att utföra antingen Ditt förvärvsarbete eller andra dagliga aktiviteter ? 1 2 3 4 7. Har Du varit begränsad i Dina möjligheter att utöva Dina hobbies eller andra 1 2 3 4 fritidssysselsättningar ?

8. Har Du blivit andfådd ? 1 2 3 4

9. Har Du haft ont ? 1 2 3 4

10. Har Du behövt vila ? 1 2 3 4

11. Har Du haft svårt att sova ? 1 2 3 4

12. Har Du känt dig svag ? 1 2 3 4

13. Har Du haft dålig aptit ? 1 2 3 4

14. Har Du känt dig illamående ? 1 2 3 4

15. Har Du kräkts ? 1 2 3 4

16. Har Du varit förstoppad ? 1 2 3 4

Under veckan som gått: Inte En hel alls Lite del Mycket 17. Har Du haft diarré ? 1 2 3 4

18. Har Du varit trött ? 1 2 3 4

19. Har Dina dagliga aktiviteter påverkats av smärta ? 1 2 3 4

20. Har Du haft svårt att koncentrera Dig, t.ex. 1 2 3 4 läsa tidningen eller se på TV ? 21. Har Du känt Dig spänd ? 1 2 3 4

22. Har Du oroat Dig ? 1 2 3 4

23. Har Du känt Dig irriterad ? 1 2 3 4

24. Har Du känt Dig nedstämd ? 1 2 3 4

25. Har Du haft svårt att komma ihåg saker ? 1 2 3 4

26. Har Ditt fysiska tillstånd eller den medicinska behandlingen stört Ditt familjeliv ? 1 2 3 4 27. Har Ditt fysiska tillstånd eller den medicinska behandlingen stört Dina sociala aktiviteter ? 1 2 3 4 28. Har Ditt fysiska tillstånd eller den medicinska behandlingen gjort att Du fått ekonomiska ? 1 2 3 4 svårigheter ?

Sätt en ring runt den siffra mellan 1 och 7 som stämmer bäst in på Dig för följande frågor: 29. Hur skulle Du vilja beskriva Din hälsa totalt sett under den vecka som gått ? 1 2 3 4 5 6 7

30. Hur skulle Du vilja beskriva Din totala livskvalitet under den vecka som gått ? 1 2 3 4 5 6 7

EORTC QLQ-H&N 35 Patienter uppger ibland att de har följande symptom eller problem. Var vänlig och ange i vilken grad Du har haft dessa besvär under veckan som gått. Sätt en ring runt den siffra som stämmer för Dig. Under veckan som gått: Inte En hel alls Lite del Mycket 31. Har Du haft smärtor i munnen ? 1 2 3 4

32. Har Du haft smärtor i käken ? 1 2 3 4

33. Har Du haft sveda i munnen ? 1 2 3 4

34. Har Du haft smärtor i svalget ? 1 2 3 4

35. Har Du haft problem med att svälja flytande ? 1 2 3 4

36. Har Du haft problem med att svälja mosad mat ? 1 2 3 4

37. Har Du haft problem med att svälja fast föda ? 1 2 3 4

38. Har Du ”satt i halsen” när Du svalt ? 1 2 3 4

39. Har Du haft problem med tänderna ? 1 2 3 4

40. Har Du haft problem med att gapa ? 1 2 3 4

41. Har Du varit torr i munnen ? 1 2 3 4

42. Har saliven varit seg ? 1 2 3 4

43. Har Du haft problem med luktsinnet ? 1 2 3 4

44. Har Du haft problem med smaksinnet ? 1 2 3 4

45. Har Du hostat ? 1 2 3 4

46. Har Du varit hes ? 1 2 3 4

47. Har Du känt Dig sjuk ? 1 2 3 4

48. Har Ditt utseende besvärat Dig ? 1 2 3 4

Under veckan som gått: Inte En hel alls Lite del Mycket 49. Har Du haft problem med att äta ? 1 2 3 4

50. Har Du haft svårt att äta inför familjen ? 1 2 3 4

51. Har Du haft svårt att äta inför andra människor ? 1 2 3 4

52. Har Du haft svårt att njuta av måltiderna ? 1 2 3 4

53. Har Du haft svårt att prata med andra människor ? 1 2 3 4

54. Har Du haft problem med att prata i telefon ? 1 2 3 4

55. Har Du haft svårt att umgås med Din familj ? 1 2 3 4

56. Har Du haft svårt att umgås med Dina vänner ? 1 2 3 4

57. Har Du haft svårt för att gå ut offentligt bland andra människor ? 1 2 3 4

58. Har Du haft svårt för fysisk kontakt med Din familj eller Dina vänner ? 1 2 3 4

59. Har Du känt Dig mindre intresserad av sex ? 1 2 3 4

60. Har Du känt mindre sexuell njutning ? 1 2 3 4

Under veckan som gått: Nej Ja

61. Har Du använt smärtstillande mediciner ? 1 2

62. Har Du tagit något näringstillskott (förutom vitaminer) ? 1 2

63. Har Du haft matsond ? 1 2

64. Har Du gått ner i vikt ? 1 2

65. Har Du gått upp i vikt ? 1 2

Under veckan som gått: Inte En hel alls Lite del Mycket 49. Har Du haft problem med att äta ? 1 2 3 4

50. Har Du haft svårt att äta inför familjen ? 1 2 3 4

51. Har Du haft svårt att äta inför andra människor ? 1 2 3 4

52. Har Du haft svårt att njuta av måltiderna ? 1 2 3 4

53. Har Du haft svårt att prata med andra människor ? 1 2 3 4

54. Har Du haft problem med att prata i telefon ? 1 2 3 4

55. Har Du haft svårt att umgås med Din familj ? 1 2 3 4

56. Har Du haft svårt att umgås med Dina vänner ? 1 2 3 4

57. Har Du haft svårt för att gå ut offentligt bland andra människor ? 1 2 3 4

58. Har Du haft svårt för fysisk kontakt med Din familj eller Dina vänner ? 1 2 3 4

59. Har Du känt Dig mindre intresserad av sex ? 1 2 3 4

60. Har Du känt mindre sexuell njutning ? 1 2 3 4

Under veckan som gått: Nej Ja

61. Har Du använt smärtstillande mediciner ? 1 2

62. Har Du tagit något näringstillskott (förutom vitaminer) ? 1 2

63. Har Du haft matsond ? 1 2

64. Har Du gått ner i vikt ? 1 2

65. Har Du gått upp i vikt ? 1 2

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1. Jag känner mig spänd eller nervös:

3 Mestadels

2 Ofta 1 Av och till 0 Inte alls

2. Jag uppskattar fortfarande saker jag tidigare uppskattat:

0 Definitivt lika mycket

1 Inte lika mycket 2 Endast delvis 3 Nästan inte alls

3. Jag har en känsla av att något hemskt kommer att hända:

3 Mycket klart och obehagligt

2 Inte så starkt nu 1 Betydligt svagare nu 0 Inte alls

4. Jag kan skratta och se det roliga i saker och ting:

0 Lika ofta som tidigare

1 Inte lika ofta nu 2 Betydligt mer sällan nu 3 Aldrig

Läs igenom varje påstående och ringa in det alternativ som bäst beskriver hur du har känt dig den senaste veckan. Fundera inte för länge över dina svar; din spontana reaktion inför varje påstående är förmodligen mer korrekt än ett svar som du tänkt på länge.

5. Jag bekymrar mig över saker:

3 Mestadels

2 Ganska ofta 1 Av och till 0 Någon enstaka gång

6. Jag känner mig på gott humör:

3 Aldrig

2 Sällan 1 Ibland 0 Mestadels

7. Jag kan sitta stilla och känna mig avslappnad:

0 Definitivt

1 Vanligtvis 2 Sällan 3 Aldrig

8. Allting känns trögt:

3 Nästan alltid

2 Ofta 1 Ibland 0 Aldrig

HAD(självskattningsskala)

Namn Datum

Ångest(udda frågenummer)

9. Jag känner mig orolig, som om jag hade ”fjärilar” i magen:

0 Aldrig

1 Ibland 2 Ganska ofta 3 Väldigt ofta

10. Jag har tappat intresset för hur jag ser ut:

3 FulIständigt

2 Till stor del 1 Delvis 0 Inte alls

11. Jag känner mig rastlös:

3 Väldigt ofta

2 Ganska ofta 1 Sällan 0 Inte alls

12. Jag ser med glädje fram emot saker och ting:

0 Lika mycket som tidigare

1 Mindre än tidigare 2 Mycket mindre än tidigare 3 Knappast alls

13. Jag får plötsliga panikkänslor:

3 Väldigt ofta

2 Ganska ofta 1 Sällan 0 Aldrig

14. Jag kan uppskatta en god bok, ett TV- eller radioprogram:

0 Ofta

1 Ibland 2 Sällan 3 Mycket sällan

Wyeth AB

Poängen på frågorna med udda nummer (1 tom 13) visar totalpoängen för ångest. Poängen på frågorna med jämna nummer (2 tom 14) visar totalpoängen för depression. Lägg samman poängen från båda sidor av formuläret och ange summan för depression och ångest i respektive ruta.

Depression(jämna frågenummer)

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Treating radiation-induced trismus in head and neck cancer

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