Association between radiation dose to organs at risk and acute patient reported outcome during radiation treatment for head and neck cancers

BACKGROUND

Associations between patient-reported outcomes and dose to organs at risk (OARs) may promote management and guide future investigations.

METHODS

We retrospectively evaluated PROs and OAR dose in head and neck (H&N) cancer.

RESULTS

In 169 patients, we identified weak associations between: "Difficulty swallowing/chewing" and increased mean RT dose to the oral cavity, larynx, pharyngeal constrictor muscles (PCM) and contralateral parotid; "choking/coughing" and larynx mean dose; "problems with mucus in mouth and throat" and oral cavity, contralateral parotid mean dose and parotid V30, contralateral submandibular gland and PCM mean dose; "difficulty with voice/speech" and oral cavity, contralateral parotid, contralateral submandibular gland and larynx mean dose; and "dry mouth" and ipsilateral submandibular gland, oral cavity and PCM mean dose.

CONCLUSION

We identified weak associations between PRO and dose to OARs-these data can guide on treatment management, patient counseling, and serve as a baseline for future investigations.

Patient reported outcomes in patients with head and neck cancer treated with concurrent chemoradiation with weekly versus bolus cisplatin

BACKGROUND

Patient Reported Outcome (PRO) data comparing bolus (B-CP) with weekly (W-CP) cisplatin concurrent with radiation are lacking.

METHODS

We performed a retrospective study comparing PRO among 99 patients with head and neck radiation, 26% who received concurrent B-CP and 73% treated with W-CP.

RESULTS

W-CP patients had a higher Charlson comorbidity index (CCI) (P = .004). There were no differences in median cisplatin dose, PROs, percutaneous endoscopic gastrostomy (PEG) dependence or hospitalization between arms. Patients with a greater decline in their self-reported dysphagia score were more often PEG dependent at the end of radiation therapy (P = .03). There was also a trend toward PEG dependence with a higher maximum dysphagia score and greater change in aspiration score (P = .06). The maximum decline in white cell count and absolute neutrophil count were greater in the W-CP group (P = .04, P = .01).

CONCLUSION

Both B-CP and W-CP are well tolerated. PROs do not suggest a benefit to W-CP.

Ensuring head and neck oncology patients receive recommended pretreatment dental evaluations

PURPOSE

Head and neck (H&N) cancer therapy can have a detrimental effect on oral health by increasing the risk of dry mouth, dental caries, dental infection, and osteonecrosis of the jaw. Pretreatment dental evaluations are recommended for patients with H&N cancer before radiation therapy to minimize the risk of acute and long-term adverse effects. In an earlier effort to educate patients and community dentists about the importance of pretreatment dental evaluations, we created a dental instructional guide (DIG) that outlines the necessary components of the preradiation dental evaluation. Yet our program did not have a system for documenting which patients received the DIG. The aim of this project was to create a reliable system to ensure that patients are given the DIG before radiation therapy and that such patients are readily identifiable, allowing us to confirm that their dental evaluations are complete before starting treatment.

METHODS

We implemented a tracking template within the H&N oncology program at the Dana-Farber Cancer Institute that documents the date, patient, and clinician who gave the DIG. We used the Model for Improvement methodology and performed plan-do-study-act (PDSA) cycles to test and monitor the results of the template implementation.

RESULTS

We showed a significant improvement in the rate of DIG documentation from a baseline of 0% (range, 0% to 0%) to a mean of 53% (range, 0% to 100%) over 3 months (P < .01).

CONCLUSION

This intervention was the first step in creating a sustainable system for ensuring timely preradiation dental evaluation, thereby decreasing the risk of dental complications from H&N cancer therapy.