Patients with head and neck cancer (HNC) undergoing ablation with microvascular free tissue transfer (MFTT) may face challenges related to aesthetic satisfaction and appearance-related psychological functioning. These study results were published in JAMA Otolaryngology – Head & Neck Surgery.
MFTT is a complex, graduated approach to facial reconstruction. It is often saved for specific circumstances, such as highly advanced cancers. Patient-perceived aesthetic outcomes have a significant impact on psychosocial function after head and neck reconstruction.
“Patients with HNC undergoing MFTT are likely at the greatest risk for impaired aesthetic outcomes and psychosocial functioning,” the researchers explained.
The study was a single-center, cross-sectional analysis of patients who underwent HNC ablation with MFTT at the University of California, San Francisco, Medical Center. Participants completed a web-based survey exploring patient-reported outcomes regarding aesthetics and psychosocial functioning. Participants had to have completed MFTT at least 1 year prior to completing the survey. The primary study outcome was aesthetic satisfaction, which was measured using the aesthetic FACE-Q Satisfaction with Facial Appearance (SFA) scale. Secondary outcomes involved psychosocial functioning as assessed using other FACE-Q scales.
A total of 228 patients were determined to meet study criteria, among whom 124 (54.4%) completed the survey. The median follow-up time for the survey was 34.4 months after MFTT. Survey responders were median age 64 years, 63.7% were men, and 36.3% were women. Most participants had stage III or IV cancer of the oral cavity or skin and had undergone reconstruction using anterolateral thigh or osteocutaneous fibula free flaps.
The mean SFA score in this study was 61.8. Participants with osteocutaneous flaps and/or received adjuvant chemotherapy or chemoradiotherapy showed significantly reduced SFA scores. Improvements in SFA scores were also independently linked to improvements in scores with psychosocial functioning scales.
Several factors were independently related to appearance-related psychosocial functioning impairments. Factors associated with psychological functioning varied across evaluated scales. However, female sex, anxiety/depression history, use of osteocutaneous flaps, prolonged tube feeding, and/or presence of a recurrent/persisting disease were features that showed some associations with psychological functioning, depending on the scale used for analysis.
“The findings of this study suggest that patients with HNC undergoing osteocutaneous reconstruction and adjuvant (chemo)radiotherapy are at an increased risk of impaired aesthetic outcomes more than 1 year after MFTT,” the researchers concluded.
Zebolsky AL, Patel N, Heaton CM, Park AM, Seth R, Knott D. Patient-reported aesthetic and psychosocial outcomes after microvascular reconstruction for head and neck cancer. JAMA Otolaryngol Head Neck Surg. Published online July 22, 2021. doi:10.1001/jamaoto.2021.1563