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Marchi F, Bellini E, Ioppi A, Simoni F, Iandelli A, Filauro M, Mora F, Sampieri C, Peretti G. Enhancing quality of life in head and neck cancer patients: a comparative analysis of 3D exoscope-assisted surgery vs. traditional approaches. Front Surg 2024; 11:1358500. [PMID: 38689603 PMCID: PMC11058215 DOI: 10.3389/fsurg.2024.1358500] [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: 12/19/2023] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction The increasing population of survivors of head and neck carcinomas is becoming more conspicuous. Consequently, the pivotal role of quality of life, particularly elucidated through the assessment of dysphagia and dysphonia, is progressively influencing the decision-making process. The current study aims to assess whether VITOM 3D could offer a comparable post-treatment quality of life to traditional approaches for patients with laryngeal cancer and oro-hypopharyngeal cancer. Methods A case series of laryngeal cancer and oro-hypopharyngeal cancer patients treated either with an exoscopic-assisted surgical setup and with conventional treatments (transoral microsurgery and radio-chemotherapy) at the Otolaryngology Unit of IRCCS San Martino Hospital, Genoa, is presented. The post-treatment quality of life of the two cohorts were compared through the administration of the University of Washington Quality of Life Questionnaire, Voiceik Handicap Index-10, M.D. Anderson Dysphagia Inventory were administrated to both cohorts of patients. Results In the laryngeal cancer group, a total of 79 patients were included. Of these, 50.1% underwent transoral exoscope-assisted surgery, while 49.9% underwent primary transoral microscopic-assisted surgical approach. No significant differences were observed in terms of the University of Washington Quality of Life Questionnaire and Voice Handicap Index-10 between the two subgroups. Conversely, in the oro-hypopharyngeal cancer group, 43 patients were included. Of these, 37.2% underwent primary transoral exoscope-assisted surgery, while 62.8% received (chemo)radiotherapy. No notable differences were reported in terms of the University of Washington Quality of Life Questionnaire and M.D. Anderson Dysphagia Inventory between the transoral exoscope-assisted surgery and (chemo)radiotherapy subgroups. Conclusions Assessments of quality of life, conducted through the University of Washington Quality of Life Questionnaire questionnaire, dysphonia evaluations using the Voice Handicap Index-10, and dysphagia assessments employing the M.D. Anderson Dysphagia Inventory questionnaire, demonstrate analogous outcomes between conventional treatment modalities and transoral interventions utilizing the 3D exoscope.
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Affiliation(s)
- Filippo Marchi
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Bellini
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandro Ioppi
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Otorhinolaryngology, Head and Neck Surgery, “S. Chiara” Hospital, Azienda Provinciale Per I Servizi Sanitari (APSS), Trento, Italy
| | - Federica Simoni
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Iandelli
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Filauro
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Mora
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Claudio Sampieri
- Department of Experimental Medicine (DIMES), University of Genoa, Genoa, Italy
- Department of Otolaryngology, Hospital Cliníc, Barcelona, Spain
- Functional Unit of Head and Neck Tumors, Hospital Cliníc, Barcelona, Spain
| | - Giorgio Peretti
- Unit of Otorhinolaryngology-Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Genoa, Italy
- Departmentof Otorhinolaryngology, Head and Neck Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Checklin M, O'Halloran R, Foster AM, Hutchison A, Wilson T, Bowen A, Vat L, Lawson N, Lenne P, Packer RL. The health care experiences of people with head and neck cancer: A scoping review. Head Neck 2024; 46:74-85. [PMID: 37882242 DOI: 10.1002/hed.27558] [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: 09/07/2022] [Revised: 09/12/2023] [Accepted: 10/16/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Understanding health care experience in head and neck cancer (HNC) is becoming increasingly important due to changes in the disease profile, survivorship, and a greater appreciation of patient health care experience as an important outcome measure. People with HNC encounter many different types of health care professionals and health care touchpoints. METHOD Through systematic database searching, this scoping review of qualitative English-language studies describes the self-reported care experiences of those with HNC across the health care continuum, and describes the current state of the literature. RESULTS Overall, the 95 studies identified were heterogeneous and investigated a broad range of topics. Trends across studies showed research centered on hospital-based care, conducted in developed countries, with more studies on feeding than other aspects of care. Generic qualitative research frameworks, with individual interviews, were the preferred method of data collection. CONCLUSION Despite identifying many studies, there are significant gaps in our understanding of the HNC patient experience.
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Affiliation(s)
- Martin Checklin
- Epworth Healthcare, Richmond, Victoria, Australia
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Robyn O'Halloran
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Abby M Foster
- Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Monash Health, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
- Centre for Research Excellence in Aphasia Recovery & Rehabilitation, Melbourne, Victoria, Australia
| | - Alana Hutchison
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Alanna Bowen
- Alanna Bowen Speech Pathology, Melbourne, Victoria, Australia
| | - Laura Vat
- Epworth Healthcare, Richmond, Victoria, Australia
| | | | | | - Rebecca L Packer
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Maoz SL, Wang EW, Hwang PH, Choby G, Kuan EC, Fleseriu CM, Chan EP, Adappa ND, Geltzeiler M, Getz AE, Humphreys IM, Le CH, Abuzeid WM, Chang EH, Jafari A, Kingdom TT, Kohanski MA, Lee JK, Lazor JW, Nabavizadeh A, Nayak JV, Palmer JN, Patel ZM, Pinheiro-Neto CD, Resnick AC, Smith TL, Snyderman CH, St John MA, Storm PB, Suh JD, Wang MB, Sim MS, Beswick DM. Long-term quality of life after treatment in sinonasal malignancy: A prospective, multicenter study. Int Forum Allergy Rhinol 2023; 13:2030-2042. [PMID: 37082883 DOI: 10.1002/alr.23171] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/10/2023] [Accepted: 04/18/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Quality of life (QOL) for individuals with sinonasal malignancy (SNM) is significantly under-studied, yet it is critical for counseling and may impact treatment. In this study we evaluated how patient, treatment, and disease factors impact sinonasal-specific and generalized QOL using validated metrics in a large cohort over a 5-year posttreatment time frame. METHODS Patients with SNM who underwent definitive treatment with curative intent were enrolled in a prospective, multisite, longitudinal observational study. QOL was assessed using the 22-item Sino-Nasal Outcome Test (SNOT-22) and University of Washington Quality of Life Questionnaire (UWQOL) instruments at pretreatment baseline and multiple follow-ups through 5 years posttreatment. Multivariable modeling was used to determine demographic, disease, and treatment factors associated with disease-specific and generalized physical and social/emotional function QOL. RESULTS One hundred ninety-four patients with SNM were analyzed. All QOL indices were impaired at pretreatment baseline and improved after treatment. SNOT-22 scores improved 3 months and UWQOL scores improved 6 to 9 months posttreatment. Patients who underwent open compared with endoscopic tumor resection had worse generalized QOL (p < 0.001), adjusted for factors including T stage. Pterygopalatine fossa (PPF) involvement was associated with worse QOL (SNOT-22, p < 0.001; UWQOL Physical dimension, p = 0.02). Adjuvant radiation was associated with worse disease-specific QOL (p = 0.03). Neck dissection was associated with worse generalized physical function QOL (p = 0.01). Positive margins were associated with worse generalized social/emotional function QOL (p = 0.01). CONCLUSION Disease-specific and generalized QOL is impaired at baseline in patients with SNM and improves after treatment. Endoscopic resection is associated with better QOL. PPF involvement, adjuvant radiation, neck dissection, and positive margins were associated with worse QOL posttreatment.
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Affiliation(s)
- Sabrina L Maoz
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Eric W Wang
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Garret Choby
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Edward C Kuan
- Department of Otolaryngology-Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Cara M Fleseriu
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Erik P Chan
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mathew Geltzeiler
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Anne E Getz
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Ian M Humphreys
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Christopher H Le
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, Arizona, USA
| | - Waleed M Abuzeid
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Eugene H Chang
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona, Tucson, Arizona, USA
| | - Aria Jafari
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, USA
| | - Todd T Kingdom
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado, Aurora, Colorado, USA
| | - Michael A Kohanski
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jivianne K Lee
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Jillian W Lazor
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ali Nabavizadeh
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jayakar V Nayak
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - James N Palmer
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zara M Patel
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, USA
| | - Carlos D Pinheiro-Neto
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Adam C Resnick
- Center for Data Driven Discovery, Children's Hospital of Philadelphia, Pittsburgh, Pennsylvania, USA
| | - Timothy L Smith
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Carl H Snyderman
- Department of Otolaryngology-Head and Neck Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maie A St John
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Phillip B Storm
- Center for Data Driven Discovery, Children's Hospital of Philadelphia, Pittsburgh, Pennsylvania, USA
| | - Jeffrey D Suh
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Marilene B Wang
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Myung S Sim
- Department of Medicine-Statistics Core, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel M Beswick
- Department of Otolaryngology-Head and Neck Surgery, University of California Los Angeles, Los Angeles, California, USA
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Dohopolski MJ, Diao K, Hutcheson KA, Akhave NS, Goepfert RP, He W, Lei XJ, Peterson SK, Shen Y, Sumer BD, Smith BD, Sher DJ. Long-term Patient-Reported Outcomes in a Population-Based Cohort Following Radiotherapy vs Surgery for Oropharyngeal Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:697-707. [PMID: 37382943 PMCID: PMC10311423 DOI: 10.1001/jamaoto.2023.1323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/02/2023] [Indexed: 06/30/2023]
Abstract
Importance Oncologic outcomes are similar for patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with primary surgery or radiotherapy. However, comparative differences in long-term patient-reported outcomes (PROs) between modalities are less well established. Objective To determine the association between primary surgery or radiotherapy and long-term PROs. Design, Setting, and Participants This cross-sectional study used the Texas Cancer Registry to identify survivors of OPSCC treated definitively with primary radiotherapy or surgery between January 1, 2006, and December 31, 2016. Patients were surveyed in October 2020 and April 2021. Exposures Primary radiotherapy and surgery for OPSCC. Main Outcomes and Measures Patients completed a questionnaire that included demographic and treatment information, the MD Anderson Symptom Inventory-Head and Neck (MDASI-HN) module, the Neck Dissection Impairment Index (NDII), and the Effectiveness of Auditory Rehabilitation (EAR) scale. Multivariable linear regression models were performed to evaluate the association of treatment (surgery vs radiotherapy) with PROs while controlling for additional variables. Results Questionnaires were mailed to 1600 survivors of OPSCC identified from the Texas Cancer Registry, with 400 responding (25% response rate), of whom 183 (46.2%) were 8 to 15 years from their initial diagnosis. The final analysis included 396 patients (aged ≤57 years, 190 [48.0%]; aged >57 years, 206 [52.0%]; female, 72 [18.2%]; male, 324 [81.8%]). After multivariable adjustment, no significant differences were found between surgery and radiotherapy outcomes as measured by the MDASI-HN (β, -0.1; 95% CI, -0.7 to 0.6), NDII (β, -1.7; 95% CI, -6.7 to 3.4), and EAR (β, -0.9; 95% CI -7.7 to 5.8). In contrast, less education, lower household income, and feeding tube use were associated with significantly worse MDASI-HN, NDII, and EAR scores, while concurrent chemotherapy with radiotherapy was associated with worse MDASI-HN and EAR scores. Conclusions and Relevance This population-based cohort study found no associations between long-term PROs and primary radiotherapy or surgery for OPSCC. Lower socioeconomic status, feeding tube use, and concurrent chemotherapy were associated with worse long-term PROs. Further efforts should focus on the mechanism, prevention, and rehabilitation of these long-term treatment toxicities. The long-term outcomes of concurrent chemotherapy should be validated and may inform treatment decision making.
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Affiliation(s)
- Michael J. Dohopolski
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Kevin Diao
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | | | - Neil S. Akhave
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Ryan P. Goepfert
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - Weiguo He
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Xiudong Jennifer Lei
- Department of Health Services Research, MD Anderson Cancer Center, Houston, Texas
| | - Susan K. Peterson
- Department of Behavioral Science, MD Anderson Cancer Center, Houston, Texas
| | - Yu Shen
- Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas
| | - Baran D. Sumer
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Benjamin D. Smith
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - David J. Sher
- Department of Radiation Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas
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Huynh TTM, Aass HCD, Falk RS, Astrup GL, Helland Å, Bjøro T, Bjordal K, Dale E, Hellebust TP, Herlofson BB, Malinen E, Kiserud CE, Osnes T, Amdal CD. Associations between patient-reported late effects and systemic cytokines in long-term survivors of head and neck cancer treated with radiotherapy. J Cancer Surviv 2023; 17:1082-1093. [PMID: 36350483 PMCID: PMC9643919 DOI: 10.1007/s11764-022-01273-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE Head and neck cancer (HNC) treatment may lead to late effects and impaired health-related quality of life of survivors. Knowledge on long-term late effects after radiotherapy (RT) and potential underlying biological mechanisms is lacking. We assessed the prevalence of xerostomia, dysphagia, and chronic fatigue (CF) in HNC survivors ≥ 5 years post-RT, and examined associations between pro-inflammatory cytokines and late effects. METHODS In a cross-sectional study, 263 HNC survivors treated between 2007 and 2013 were enrolled. They completed validated questionnaires assessing xerostomia and dysphagia (the EORTC QLQ-H&N35), and CF (the Fatigue Questionnaire), and underwent blood sampling and clinical examination. Pro-inflammatory cytokines were analyzed in 262 survivors and 100 healthy age- and gender-matched controls. RESULTS Median time since treatment was 8.5 years. The proportions of survivors reporting xerostomia, dysphagia, and CF were 58%, 31%, and 33%, respectively, with a preponderance of females. We found no significant associations between IL-6, IL-8, IP-10, TARC, TNF, or ENA-78 and the three late effects. The odds of having elevated levels of IL-6 and IP-10 were significantly higher in the survivors compared to the controls. CONCLUSIONS More than one-third of long-term HNC survivors experienced xerostomia, dysphagia, and CF. Persistent inflammation, with elevated systemic cytokines, was not associated with these late effects, although HNC survivors had higher levels of some cytokines than the controls. IMPLICATIONS FOR CANCER SURVIVORS This study provides new knowledge on late effects that can serve as grounds for informing patients with HNC about risk of late effects more than 5 years after RT.
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Affiliation(s)
- T T M Huynh
- Faculty of Medicine, University of Oslo, Oslo, Norway.
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway.
| | - H C D Aass
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - R S Falk
- Research Support Services, Oslo University Hospital, Oslo, Norway
| | - G L Astrup
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway
| | - Å Helland
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway
| | - T Bjøro
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway
| | - K Bjordal
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Research Support Services, Oslo University Hospital, Oslo, Norway
| | - E Dale
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway
| | - T P Hellebust
- Department of Physics, University of Oslo, Oslo, Norway
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - B B Herlofson
- Faculty of Dentistry, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - E Malinen
- Department of Physics, University of Oslo, Oslo, Norway
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
| | - C E Kiserud
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway
| | - T Osnes
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology, Head and Neck Surgery, Oslo University Hospital, Oslo, Norway
| | - C D Amdal
- Department of Oncology, Oslo University Hospital, Post Box 4950, NO-0424, NydalenOslo, Norway
- Research Support Services, Oslo University Hospital, Oslo, Norway
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Barker CL, Price GJ, Lee LW, McPartlin A. Baseline MD Anderson Symptom Inventory Score is Strongly Associated With Patient-reported Acute and Late Toxicity Following (Chemo) Radiotherapy for Head and Neck Cancers. Clin Oncol (R Coll Radiol) 2022; 34:683-689. [PMID: 35688777 DOI: 10.1016/j.clon.2022.05.018] [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: 12/31/2021] [Revised: 03/07/2022] [Accepted: 05/25/2022] [Indexed: 11/27/2022]
Abstract
AIMS Patient-reported outcomes measures (PROMs) are an increasingly recognised end point of radiotherapy studies. We hypothesised that the baseline PROMs score is the strongest predictor for acute and late scores after treatment. We assessed the strength of association of baseline MD Anderson Symptom Inventory (MDASI) scores, alongside other known factors for patient- or clinician-reported toxicity, with acute (6-week) and late (12-month) scores in head and neck cancer (HNC) patients following (chemo)radiotherapy. MATERIALS AND METHODS This was a retrospective analysis of longitudinal MDASI scores for 247 patients receiving (chemo)radiotherapy for HNC via multivariable linear regression. The factors investigated were: baseline symptom score, age, sex, concurrent chemotherapy, disease stage, radiotherapy fractionation, prior definitive surgery and performance status. Patients with a baseline score >4 in any item were defined as symptomatic in that category. RESULTS Patients rated symptomatic for an MDASI item pre-treatment on average reported statistically (P < 0.0005) and clinically (>-1.5) significant reductions in scores 6 weeks and 12 months after (chemo)radiotherapy for all considered sub-items except taste, dryness of mouth and problems with teeth. Conversely patients asymptomatic at baseline reported a worsening of scores at both time points. Other investigated factors showed little association with changes in MDASI scores following treatment. CONCLUSIONS Our data show that baseline MDASI scores are strongly associated with patient-reported toxicity 6 weeks and 12 months after (chemo)radiotherapy for HNC. Patients who are symptomatic at baseline can experience an early and durable benefit from treatment. This finding can inform discussions with patients before therapy and has implications for use of PROMs scores for the assessment of toxicity in randomised trials.
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Affiliation(s)
- C L Barker
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - G J Price
- Manchester Cancer Research Centre, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK
| | - L W Lee
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - A McPartlin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
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7
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McDowell L, Rischin D, Gough K, Henson C. Health-Related Quality of Life, Psychosocial Distress and Unmet Needs in Older Patients With Head and Neck Cancer. Front Oncol 2022; 12:834068. [PMID: 35242716 PMCID: PMC8885992 DOI: 10.3389/fonc.2022.834068] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 01/24/2022] [Indexed: 01/22/2023] Open
Abstract
Head and neck squamous cell carcinoma (HNSCC) is the most common cancer involving the mucosal surfaces of the head and neck and is associated with a number of etiological factors, including cigarette smoking, alcohol and betel nut consumption and exposure to high-risk human papillomavirus. The risk of HNSCC increases with age, peaking in the seventh and eighth decade, but this varies by anatomical and histological subtype. While several advancements have been made in the treatment of head and neck cancer (HNC) in recent decades, undertaking curative treatment still subjects the majority of HNSCC patients to substantial treatment-related toxicity requiring patients to tolerate a gamut of physical, psychological, and emotional demands on their reserves. In conjunction with other patient-related factors, clinicians involved in treating patients with HNSCC may incorporate advancing chronological age into their decision-making process when determining treatment recommendations. While advancing chronological age may be associated with increased concerns regarding physical treatment tolerability, clinicians may also be concerned about heightened vulnerability in various health and wellbeing outcomes. The available literature, however, does not provide evidence of this vulnerability in patients with advancing age, and, in many instances, older patients self-report greater resilience compared to their younger counterparts. While this data is reassuring it is limited by selection bias and heterogeneity in trial and study design and the absence of a consistent definition of the elderly patient with HNSCC. This narrative review article also includes a review of the measures used to assess HRQL, psychosocial outcomes and unmet needs in elderly or older patients with HNSCC.
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Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Danny Rischin
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Karla Gough
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Department of Nursing, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, VIC, Australia
| | - Christina Henson
- Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, United States
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McDowell L, Casswell G, Bressel M, Drosdowsky A, Rischin D, Coleman A, Shrestha S, D'Costa I, Fua T, Tiong A, Liu C, Gough K. Symptom burden, quality of life, functioning and emotional distress in survivors of human papillomavirus associated oropharyngeal cancer: An Australian cohort. Oral Oncol 2021; 122:105560. [PMID: 34653749 DOI: 10.1016/j.oraloncology.2021.105560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/26/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND This cross-sectional study examines patient-reported outcomes and functioning-based subgroups in human papillomavirus-associated oropharyngeal cancer survivors treated with chemoradiotherapy ≥12 months prior. METHOD Survivors completed EORTC QLQ-C30, MDASI-HN and PROMIS-Emotional distress questionnaires. Subgroups were identified via two-step clustering of QLQ-C30 functioning scales. RESULTS 136 patients were enrolled. Clinicians' graded 19/136 (14%) patients as having at least one severe (Grade 3 CTCAE) toxicity, whereas 68/136 (50%) patients self-reported at least one toxicity in the severe range (MDASI-HN ≥ 7). QLQ-C30 Global health status score (mean 76, SD = 20) was comparable to population norms. Rates of moderate/severe anxiety (10%/1%) and depression (4%/1%) were low. Two functioning-based subgroups were formed based on auto-clustering statistics: high- (n = 93) and low-functioning (n = 41). Differences on all functioning scales were large (d: 1.57-2.29), as were differences on the remaining QLQ-C30 scales/items, most MDASI-HN symptom severity/interference scales, and PROMIS scales (d: 0.80-2.03). Differences and associations with patient/clinical characteristics were not significant. CONCLUSION In this Australian cohort of HPV-OPC survivors there was significant discordance between clinician- and patient-reported toxicity. We observed population comparable global quality of life and low rates of emotional distress. However, we identified a low-functioning subgroup reporting significantly worse outcomes on a range of patient-reported measures who may benefit from targeted support.
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Affiliation(s)
- Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.
| | - Georgina Casswell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Mathias Bressel
- Centre of Biostatistics and Clinical Trials (BaCT) Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia.
| | - Allison Drosdowsky
- Department of Cancer Experiences, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Danny Rischin
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Andrew Coleman
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Sudichhya Shrestha
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Ieta D'Costa
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Tsien Fua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Albert Tiong
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Chen Liu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia
| | - Karla Gough
- Department of Cancer Experiences, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, Australia; Department of Nursing, Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Victoria, Australia.
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Wotman MT, Miles BA, Bakst RL, Posner MR. A proposal for risk-based and strategy-adapted de-escalation in human papillomavirus-positive oropharyngeal squamous cell carcinoma. Cancer 2021; 127:4330-4338. [PMID: 34379804 DOI: 10.1002/cncr.33851] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Michael T Wotman
- The Department of Internal Medicine in the Icahn School of Medicine at Mount Sinai, New York, New York
| | - Brett A Miles
- The Department of Otolaryngology in the Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard L Bakst
- The Department of Radiation Oncology in the Icahn School of Medicine at Mount Sinai, New York, New York
| | - Marshall R Posner
- The Department of Hematology/Oncology in the Icahn School of Medicine at Mount Sinai, New York, New York
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