Sparing All Salivary Glands With IMRT for Head and Neck Cancer: Longitudinal Study of Patient-Reported Xerostomia and Head and Neck Quality Of Life

150 Background: This study sought to compare the incidence of late toxicities among survivors of head and neck cancer treated by definitive chemoradiation using patient-reported versus physician-reported methodologies. Methods: Two validated quality of life instruments, the University of Washington Quality of Life questionnaire (UW-QOL) and the Functional Assessment of Cancer Therapy for Head and Neck questionnaire (FACT-H&N) were administered to patients returning for follow-up after chemoradiation for head and neck cancer. Only patients who had been clinically without evidence of disease for greater than 6 months were sampled. Scores were compared to physician-reported toxicities, which were recorded blindly and independently after each patient visit, using the National Cancer Institute’s Common Toxicity Criteria (version 4.0). Two by two contingency tables were constructed to assess differences between patient- and physician-reported responses using Fisher’s exact test. Results: Fifty patients (35 male; 15 females) completed both instruments. While 78% of patients reported an inability “to swallow certain solid foods” and 70% reported difficulty to “swallow naturally and easily” using the self-reported UW-QOL and FACT-H&N surveys, respectively, the incidence of grade 2+ esophageal dysfunction as reported by physicians was only 48% (p < 0.001). While 60% of patients reported “too little saliva” and 50% acknowledged having problems with "voice quality and strength" using the UW-QOL and FACT-H&N surveys, only 20% and 30%, respectively, were scored as having grade 2+ xerostomia and laryngeal toxicity. Significant discordance was also observed between patient- and physician-reported toxicities with respect to the domains of appearance (p = 0.02), pain (p = 0.01), activity/energy (p < 0.001), and mood (p = 0.001). Conclusions: Late toxicities are frequently under-reported by physicians after chemoradiation for head and neck cancer. The true incidence and severity of these treatment-related toxicities, with respect to both functional and psychosocial impairment, among survivors may be better evaluated by patient-reported methods.

Download Full-text

Quality of Life and Performance in Advanced Head and Neck Cancer Patients on Concomitant Chemoradiotherapy: A Prospective Examination

Journal of Clinical Oncology ◽

10.1200/jco.1999.17.3.1020 ◽

1999 ◽

Vol 17 (3) ◽

pp. 1020-1020 ◽

Cited By ~ 169

Author(s):

Marcy A. List ◽

Amy Siston ◽

Daniel Haraf ◽

Phil Schumm ◽

Merrill Kies ◽

...

Keyword(s):

Quality Of Life ◽

Head And Neck Cancer ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Performance Status ◽

Functional Impairments ◽

Concomitant Chemoradiotherapy ◽

Patient Reported

PURPOSE: To prospectively evaluate performance and quality of life (QOL) in advanced-stage head and neck cancer (HNC) patients on a curative-intent, concomitant-chemoradiotherapy (CT/XRT) (twice-daily radiation, fluorouracil, hydroxyurea, and cisplatin) regimen aimed at improving locoregional control, survival, and QOL. PATIENTS AND METHODS: Sixty-four patients were assessed before, during, and at 3-month intervals after treatment. Standardized measures of QOL (Functional Assessment of Cancer Therapy–Head and Neck), performance (Performance Status Scale for Head and Neck Cancer Patients and Karnofsky Performance Status Rating Scale), and patient-reported symptoms (McMaster University Head and Neck Radiotherapy Questionnaire) were administered. RESULTS: Acute treatment toxicities were severe, with declines in virtually all QOL and functional domains. Marked improvement was seen by 12 months; general functional and physical measures returned to baseline levels of good to excellent. Although up to a third of the patients continued to report problems with swallowing, hoarseness, and mouth pain, these difficulties were present in similar magnitudes before treatment. The following symptoms were more frequent at 12 months: dry mouth (58% v 17%), difficulties tasting (32% v 8%), and soft food diet (82% v 42%). Twelve-month diet was not related to pretreatment functioning, disease, treatment, or patient characteristics. Twelve-month QOL was best predicted by pretreatment QOL, with very little relationship to residual side effects or functional impairments. Small numbers of patients in four of the five disease sites precluded examination of outcome by site. CONCLUSION: These data support the feasibility of intense CT/XRT as primary treatment for advanced HNC. Results confirm acute toxicity but indicate that many of the treatment-related performance and QOL declines resolve by 12 months. The persistent inability to eat a full range of foods warrants further attention and monitoring.

Download Full-text