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Ramalingam K, Yadalam PK, Ramani P, Krishna M, Hafedh S, Badnjević A, Cervino G, Minervini G. Light gradient boosting-based prediction of quality of life among oral cancer-treated patients. BMC Oral Health 2024; 24:349. [PMID: 38504227 PMCID: PMC10949789 DOI: 10.1186/s12903-024-04050-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 02/19/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND AND INTRODUCTION Statisticians rank oral and lip cancer sixth in global mortality at 10.2%. Mouth opening and swallowing are challenging. Hence, most oral cancer patients only report later stages. They worry about surviving cancer and receiving therapy. Oral cancer severely affects QOL. QOL is affected by risk factors, disease site, and treatment. Using oral cancer patient questionnaires, we use light gradient Boost Tree classifiers to predict life quality. METHODS DIAS records were used for 111 oral cancer patients. The European Organisation for Research and Treatment of Cancer's QLQ-C30 and QLQ-HN43 were used to document the findings. Anyone could enroll, regardless of gender or age. The IHEC/SDC/PhD/OPATH-1954/19/TH-001 Institutional Ethical Clearance Committee approved this work. After informed consent, patients received the EORTC QLQ-C30 and QLQ-HN43 questionnaires. Surveys were in Tamil and English. Overall, QOL ratings covered several domains. We obtained patient demographics, case history, and therapy information from our DIAS (Dental Information Archival Software). Enrolled patients were monitored for at least a year. After one year, the EORTC questionnaire was retaken, and scores were recorded. This prospective analytical exploratory study at Saveetha Dental College, Chennai, India, examined QOL at diagnosis and at least 12 months after primary therapy in patients with histopathologically diagnosed oral malignancies. We measured oral cancer patients' quality of life using data preprocessing, feature selection, and model construction. A confusion matrix was created using light gradient boosting to measure accuracy. RESULTS Light gradient boosting predicted cancer patients' quality of life with 96% accuracy and 0.20 log loss. CONCLUSION Oral surgeons and oncologists can improve planning and therapy with this prediction model.
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Affiliation(s)
- Karthikeyan Ramalingam
- Department of Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
| | - Pradeep Kumar Yadalam
- Department of Periodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Science (SIMATS), Saveetha University, Chennai, India.
| | - Pratibha Ramani
- Department of Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
| | - Murugesan Krishna
- Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
| | - Salah Hafedh
- Orthodontics Department, Faculty of Dentistry, Sana'a University, Sana'a, Yemen.
| | - Almir Badnjević
- Verlab Research Institute for Biomedical Engineering, Medical Devices, and Artificial Intelligence, Ferhadija 27, Sarajevo, 71 000, Bosnia and Herzegovina
| | - Gabriele Cervino
- Dental Sciences and Morphofunctional Imaging, University of Messina - Policlinico "Gaetano Martino", Via Consolare Valeria, Messina, ME, 98100, Italy
| | - Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
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Hung CY, Hsu MH, Lee SH, Hsueh SW, Lu CH, Yeh KY, Wang HM, Chang JTC, Hung YS, Chou WC. Impact of pretreatment quality of life on tolerance and survival outcome in head and neck cancer patients undergoing definitive CCRT. J Formos Med Assoc 2024:S0929-6646(24)00055-X. [PMID: 38331637 DOI: 10.1016/j.jfma.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/28/2023] [Accepted: 01/20/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is a predictor of treatment outcomes in cancer patients. This study aimed to evaluate the effect of pretreatment HRQoL on treatment tolerance and survival outcomes in patients with HNC planned for concurrent chemoradiotherapy (CCRT) in Taiwan. METHODS This study included 461 patients with HNC planned for definitive CCRT at three medical centers in Taiwan between August 2017 and December 2018. HRQoL was assessed using the QLQ-HN35 one week before the initiation of CCRT. Patients were grouped based on the sum scores of QLQ-HN35 ( RESULTS The median QLQ-HN35 sum score among 461 patients was 39 (range, 30 to 96), varying with tumor site: 34 for nasopharynx, 44 for oropharynx, 45 for oral cavity, and 38 for hypopharynx. Patients with sum scores ≥ median were associated with higher risk for incomplete CCRT (13.4 % vs 6.5 %, odds ratio [OR] = 2.22, 95 % confidence interval [CI] = 1.17-4.24, p = 0.015), emergency room visits (36.4 % vs 27.0 %, OR = 1.55, 95 % CI = 1.04-2.30, p = 0.030), unexpected hospitalization (33.8 % vs 19.6 %, OR = 2.10, 95 % CI = 1.37-3.21, p = 0.001), ≥ grade 3 hematological toxicities (34.2 % vs 21.3 %, OR = 1.92, 95 % CI = 1.27-2.91, p = 0.002), ≥ grade 3 non-hematological toxicities (78.8 % vs 68.7 %, OR = 1.69, 95 % CI = 1.11-2.58, p = 0.014), and low survival outcomes (hazard radio = 2.76, 95 % CI = 1.67-4.54, p < 0.001). Patients with lower sum scores in nasopharyngeal/oropharyngeal tumors exhibited better OS than those with higher scores, while no significant difference in OS based on HRQoL was observed in oral cavity/hypopharyngeal cancer patients. Higher sum scores remained a negative indicator even after adjusting for other confounding factors. CONCLUSION In patients with HNC planned for definitive CCRT, pre-treatment HRQoL was significantly associated with treatment-related complications, tolerance, and survival outcomes. Furthermore, our results validated the clinical value of QLQ-HN35 as an indicator for predicting treatment tolerance and outcomes.
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Affiliation(s)
- Chia-Yen Hung
- Department of Hematology and Oncology, Chang Gung University, Taoyuan, Taiwan; Division of Hema-oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Mei-Hui Hsu
- Department of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Hui Lee
- Department of Nursing, Chang Gung University, Taoyuan, Taiwan
| | - Shun-Wen Hsueh
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Chang-Hsien Lu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Kun-Yun Yeh
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Hung-Ming Wang
- Department of Hematology and Oncology, Chang Gung University, Taoyuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shin Hung
- Department of Hematology and Oncology, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung University, Taoyuan, Taiwan.
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Lu CH, Hung CY, Hsueh SW, Yeh KY, Hung YS, Chou WC. Frailty is an independent factor for health-related quality of life in patients with head and neck cancer receiving definitive concurrent chemoradiotherapy. Support Care Cancer 2024; 32:106. [PMID: 38221588 DOI: 10.1007/s00520-024-08313-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE Health-related quality of life (HRQoL) is associated with treatment-related complications and poor survival in patients with head and neck cancer (HNC). We investigated the effects of frailty on HRQoL in patients with HNC receiving definitive concurrent chemoradiotherapy (CCRT). METHODS A total of 461 consecutive patients with locally advanced HNC who received CCRT between 2017 and 2018 at three medical centers in Taiwan were included. Frailty and HRQoL were assessed using the Comprehensive Geriatric Assessment and QLQ-H&N35 before CCRT. The sum score was calculated based on the first 30 questions of QLQ-H&N35. Multivariate analysis was performed to evaluate the impact of frailty on HRQoL. RESULTS The overall sum score was 39 (34-49). The sum scores of patients with impairments in 0, 1, 2, 3, and ≥ 4 frailty domains were 34 (32-38), 40 (34-47), 46 (36-55), 48 (41-64), and 56 (50-60), respectively. Patients with impairments in more frailty domains had a higher symptom burden (p for trend < 0.001). Frail patients tended to experience symptoms across all QLQ-H&N35 subscales. Sex, body mass index, tumor type, tumor stage, Eastern Cooperative Oncology Group performance status, and frailty were determinants of HRQoL in the univariate analysis. Frailty was an independent determinant of HRQoL in the multivariate analysis. CONCLUSION Routine frailty assessment may serve as a surrogate for the selection of patients with HNC with poor HRQoL before CCRT. Further studies are needed to determine whether appropriate interventions in frail patients would improve their HRQoL during CCRT.
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Affiliation(s)
- Chang-Hsien Lu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Chia-Yen Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
- Division of Hematology and Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Shun-Wen Hsueh
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Kun-Yun Yeh
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Yu-Shin Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan.
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Yu SM, Hsu CC, Hsueh SW, Hung CY, Lu CH, Yeh KY, Wang HM, Lin SY, Hung YS, Chou WC. Frailty assessment by two screening instruments in non-elderly patients with head and neck cancer. Oral Oncol 2023; 147:106621. [PMID: 37931492 DOI: 10.1016/j.oraloncology.2023.106621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023]
Abstract
PURPOSE Frailty assessment is often overlooked in non-elderly patients with cancer, possibly due to the lack of an effective frailty screening tool. This study aimed to evaluate the performance of two modern frailty screening tools, the Flemish version of the Triage Risk Screening Tool (fTRST) and the modified 5-Item Frailty Index (mFI-5), compared to the gold standard comprehensive geriatric assessment (GA) among non-elderly patients with head and neck cancer (HNC). METHODS We prospectively included 354 consecutive patients aged < 65 years with newly diagnosed HNC scheduled for definitive concurrent chemoradiotherapy (CCRT) at three academic hospitals in Taiwan between January 2020 and December 2022. Frailty assessment using the GA, fTRST, and mFI-5 was performed in all patients to evaluate the relationship between frailty and treatment outcomes. RESULTS The prevalence of frailty was 27.1%, 37.0%, and 42.4% based on GA, mFI-5, and fTRST, respectively. mFI-5 and fTRST demonstrated good predictive value in identifying frail patients compared to the GA. Patients with frailty, as defined by GA, mFI-5, and fTRST, exhibited higher risks of treatment-related complications, incomplete treatment, and poorer baseline quality of life (QoL). However, only GA showed significant prognostic value for overall survival. CONCLUSIONS Frailty assessment using fTRST and mFI-5 is valuable for predicting treatment-related adverse events, treatment tolerance, and QoL in non-elderly patients with HNC. Incorporating frailty assessment into the management of non-elderly cancer patients can aid in the identification of high-risk individuals. However, the performance of these tools varies, highlighting the need for further validation and refinement.
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Affiliation(s)
- Shao-Ming Yu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Chung Hsu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shun-Wen Hsueh
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chia-Yen Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Hematology and Oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Chang-Hsien Lu
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan
| | - Kun-Yun Yeh
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Hung-Ming Wang
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shinn-Yn Lin
- Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Shin Hung
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wen-Chi Chou
- Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Moratin J, Zittel S, Horn D, Behnisch R, Ristow O, Engel M, Hoffmann J, Freier K, Freudlsperger C. Free-Flap Reconstruction in Early-Stage Squamous Cell Carcinoma of the Oral Cavity-A Prospective Monocentric Trial to Evaluate Oncological Outcome and Quality of Life. J Clin Med 2023; 12:4833. [PMID: 37510948 PMCID: PMC10381471 DOI: 10.3390/jcm12144833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/28/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Surgery is generally accepted as standard treatment in oral cancer, but the reconstructive procedures remain a matter of debate. The aim of this study was to evaluate oncological outcome and quality of life following surgical resection and free-flap reconstruction in patients with early oral squamous cell carcinoma. The presented trial was performed as a prospective, single-center observation study. Inclusion criteria were primary surgery in early-stage oral squamous cell carcinoma with free-flap reconstruction. Endpoints were overall and progression-free survival and quality of life up to 24 months after surgery. Twenty-six patients were included. Overall survival was 100% and progression-free survival was 92.3% in a maximum follow-up time of 21 months. Global quality of life showed no significant alteration after surgery. Patients reported a significant reduction in pain (p = 0.048) and a decreasing impairment of speech one year after surgery (p = 0.021). Free-flap reconstruction is a safe procedure that results in excellent oncological outcome and quality of life. Functional outcome is of high relevance in early-stage tumors of the head and neck and may mostly be affected by reconstructive procedures. Therefore, a prospective evaluation to explore success and the effects of surgical therapy is highly warranted.
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Affiliation(s)
- Julius Moratin
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Sven Zittel
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Dominik Horn
- Department of Oral and Cranio-Maxillofacial Surgery, Saarland University Medical Center, Kirrberger Straße, 66424 Homburg, Germany
| | - Rouven Behnisch
- Institute of Medical Biometry, University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Oliver Ristow
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Michael Engel
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Kolja Freier
- Department of Oral and Cranio-Maxillofacial Surgery, Saarland University Medical Center, Kirrberger Straße, 66424 Homburg, Germany
| | - Christian Freudlsperger
- Department of Oral and Cranio-Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
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Balaguer M, Pommée T, Pinquier J, Farinas J, Woisard V, Sordes F. Development and Preliminary Validation of the Questionnaire "Evaluation of the Constitution of Social Circles" in Patients Treated for Cancer of the Upper Aerodigestive Tract. Folia Phoniatr Logop 2023; 75:52-66. [PMID: 35665696 DOI: 10.1159/000525352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/19/2022] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The constitution of social circles around patients treated for cancer of the upper aerodigestive tract (UADT) has a major influence on factors that affect quality of life (QOL) but is poorly assessed, mainly due to a lack of tools. The objective of this study is to develop a questionnaire that assesses the constitution of social circles in a population treated for UADT cancer and to analyze the construct (structural and clinical validity) and criterion validity. METHODS The Evaluation of the Constitution of Social Circles (ECSC) questionnaire was developed in French by a committee of experts. Structural validity was analyzed using inter-item correlations. The scores of a group of patients treated for UADT cancer were compared with those of a group of healthy subjects (clinical validity). For criterion validity, the ECSC scores were compared to those from various questionnaires that assess social functioning (QFS), psychological status (HAD), perceived speech impairment (PHI), and QOL (EORTC QLQ-H&N35) in patients. RESULTS Structural validity shows low to moderate inter-item correlations which is consistent with the construction of the questionnaire not assessing underlying concepts. Clinical validity was satisfactory regarding the frequency of contact (p = 0.01), satisfaction with the frequency of contact in the private circle (p = 0.03), and the size of the social circles of family and friends (p ≤ 0.01). Criterion validity was adequate with moderate correlations between the ECSC scores and the QFS sub-scores of interest (rs > 0.56, p < 0.05). Anxiety (HAD) had a low correlation (|rs| = 0.46, p < 0.05) with satisfaction with exchanges and the frequency of contact with family. Satisfaction with exchanges with the private circle was moderately correlated with the EORTC QLQ-H&N35 score (rs = 0.56, p = 0.01) and showed a negative trend on the PHI (rs < -0.39, p ≥ 0.05). CONCLUSION While the test-retest reliability is yet to be evaluated and the sample size should be increased, this preliminary study shows that the ECSC is a valid tool for assessing the constitution of social circles in patients treated for UADT cancer. It highlights the links between social circles and their functional impact on communication and QOL.
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Affiliation(s)
- Mathieu Balaguer
- IRIT, CNRS, Université Paul Sabatier, Toulouse, France.,ENT Department, CHU Larrey, Toulouse, France
| | | | | | | | - Virginie Woisard
- ENT Department, CHU Larrey, Toulouse, France.,Laboratoire de Neuro-Psycho-Linguistique, Université Toulouse Jean Jaurès, Toulouse, France.,Oncorehabilitation Unit, University Cancer Institute, Toulouse, France
| | - Florence Sordes
- Laboratoire CERPPS, Pôle 3: psychologie de la santé, Université de Toulouse, Toulouse, France
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Assessment of Quality of Life in Head-and-Neck Oncologic Patients with Intraoral Soft-Tissue Defects Reconstructed with Buccinator Myomucosal Flap. J Clin Med 2022; 11:jcm11247458. [PMID: 36556074 PMCID: PMC9780850 DOI: 10.3390/jcm11247458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The aim of this study is to evaluate the functional outcomes and quality of life (QoL) in oncologic patients with intraoral defects reconstructed with the buccinator myomucosal flap. A retrospective study was performed involving 39 patients with intraoral soft-tissue defects, reconstructed with a buccinator myomucosal flap during a six-year period. Patients completed the European Organization for Research and Treatment of Cancer questionnaires, the standard questionnaire (QLQ-C30) and the head-and-neck specific module (QLQ-H&N35). Thirty-nine patients with a mean age of 61.23 ± 15.80 years were included in the study. Thirty-three patients were diagnosed with an oncological condition (84.61%). Six patients (15.38%) developed orosinusal communication and underwent extensive debridement. The median global-health-status score was 79.27 and emotional performance was the lowest scoring, with a mean score of 76.93. As for the symptom items, the most outstanding were dental problems (33.33), oral opening (31.62) and dry mouth (37.61), followed by sticky saliva (24.79), problems with social eating (21.15) and pain (19.87). The most significant symptoms were radiotherapy-related adverse effects such as pain, fatigue, dental problems and dry mouth. Patients reconstructed with the buccinator myomucosal flap develop a good quality of life for all types of activities, and a correct function and aesthetics. Postoperative radiotherapy is associated with a poorer quality of life, and can lead to impairment of several symptoms such as swallowing, oral opening and dry mouth.
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Sher DJ, Radpour S, Shah JL, Pham NL, Jiang S, Vo D, Sumer BD, Day AT. Pilot Study of a Wearable Activity Monitor During Head and Neck Radiotherapy to Predict Clinical Outcomes. JCO Clin Cancer Inform 2022; 6:e2100179. [PMID: 35333597 PMCID: PMC8970084 DOI: 10.1200/cci.21.00179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Given the established associations between performance status and survival in a variety of cancers, there is significant interest in using a biometric wearable device (WD) to predict outcomes in the oncology population. In this pilot study, we investigated the ability of a WD to predict meaningful clinical end points in patients undergoing head and neck radiotherapy. METHODS Patients receiving head and neck definitive chemoradiotherapy or postoperative radiotherapy/chemoradiotherapy were enrolled in this pilot study, designed to show 90% compliance with using the device. Individuals were asked to wear the WD for 23 hours a day, and hospital admissions, pain medication usage, and FACT-G quality-of-life (QoL) score were prospectively recorded. RESULTS Fifty-one patients were enrolled and started using the WD, but eight patients stopped wearing it, resulting in a compliance probability of only 84%. There were 15 hospital admissions, 13 of which were planned for feeding tube placement. There was no step count threshold that predicted the need for admission or more pain medications. However, among the 25 patients with a significant reduction in FACT-G score, the average reductions in daily steps during the week and weekend before the decline were 988 (P = .005) and 1,311 (P = .018), respectively, and the odds of a QoL reduction were more than 4-fold higher among patients experiencing a week-to-week reduction of at least 1,000 daily steps. There was no association between heart rate and any end point. CONCLUSION Although not meeting the compliance goal, the majority of patients did use the WD. The WD signal could not identify patients requiring hospitalization or significantly more pain medication, but the finding of reduced step counts before a significant reduction in QoL is provocative.
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Affiliation(s)
- David J. Sher
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
- David J. Sher, MD, MPH, Department of Radiation Oncology, UT Southwestern Medical Center, 2280 Inwood Dr, Dallas, TX 75390; e-mail:
| | - Sepeadeh Radpour
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Jennifer L. Shah
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Nhat-Long Pham
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Steve Jiang
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Dat Vo
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Baran D. Sumer
- Department of Otolaryngology, UT Southwestern Medical Center, Dallas, TX
| | - Andrew T. Day
- Department of Otolaryngology, UT Southwestern Medical Center, Dallas, TX
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