Long-term patient reported outcomes following radiation therapy for oropharyngeal cancer: A symptom assessment study in patients >65 years old.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21611-e21611 ◽  
Author(s):  
Salman Ali Eraj ◽  
Mona K Jomaa ◽  
Crosby Douglas Rock ◽  
Abdallah Mohamed ◽  
Adam S. Garden ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Oropharyngeal Cancer ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Distinct Pattern ◽  
Assessment Tools ◽  
Dry Mouth ◽  
Patient Reported

e21611 Background: Given the potential for older patients (pts) to experience exaggerated toxicity and symptoms, this study was performed to characterize pt reported outcomes (PROs) in older pts following definitive radiation therapy (RT) for oropharyngeal cancer (OPC). Methods: Disease-free head and neck cancer survivors ( > 6 mos. since tx) were eligible for participation in a questionnaire-based study. Participants completed the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN). Those who had been treated for OPC with definitive RT (w/ or w/o systemic therapy) and were > 65 y/o at time of RT were included. Individual and overall symptom severity and clinical variables were analyzed. Results: Of the 79 participants analyzed, 82% were male, 95% white, 41% T3/4 disease, 39% RT alone, 27% induction chemotherapy, 52% concurrent, and 18% both, and 96% IMRT. Median age at the time of RT was 71 yrs. (range: 65-85); median time from end of RT to MDASI-HN completion was 46 mos. (2/3 > 24 mos.). The top 5 MDASI-HN items rated most severe in terms of mean (±SD) ratings (0-10 scale) were dry mouth (3.48±2.95), taste (2.81±3.29), swallowing (2.59±2.96), mucus in mouth/throat (2.04±2.68), and choking (1.30±2.38) reported at moderate to severe levels (≥5) by 35, 29, 29, 18, and 13%, respectively. Thirty-nine % reported none (0) or no more than mild (1-4) symptoms across all 22 MDASI-HN symptoms items, and 38% had at least one item rated as severe (≥7). Hierarchal cluster analysis resulted in 3 patient groups: 1) ~75% with generally no to moderate symptom burden, 2) ~25% with moderate to severe ratings for a subset of classically RT-related symptoms (e.g. dry mouth, mucus, swallow, taste), and 3) only 2 pts with severe ratings of nearly all items. Subgroup comparisons will be presented. Conclusions: The overall long-term symptom burden seen in this older OPC cohort was largely favorable, yet a higher symptom group (~25%) with a distinct pattern of mostly local symptoms was identified. We have implemented the routine use of symptom assessment tools as part of OPC survivorship programs and plan to explore age-dose-modeling of symptoms identified and associated normal structures.

Quality of life analysis of HPV-positive oropharyngeal cancer patients in a randomized trial of reduced-dose (rdCRT) versus standard (sdCRT) chemoradiotherapy: Five-year follow-up.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6062-6062
Author(s):  
Mai Takahashi ◽  
Michael Hwang ◽  
Krzysztof Misiukiewicz ◽  
Richard Lorne Bakst ◽  
Brett A. Miles ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomized Trial ◽  
Head And Neck ◽  
Oropharyngeal Cancer ◽  
Locally Advanced ◽  
Patient Reported ◽  
Md Anderson

6062 Background: Human papillomavirus-positive oropharyngeal cancer (HPV OPC) portends a more favorable prognosis compared to HPV-negative cases. To prevent overtreatment, long-term morbidity and deterioration in functionality and quality of life (QoL), multiple studies have focused on de-intensification techniques for HPV OPC treatment. To this end, we prospectively assessed differences in patient reported QoL in locally advanced HPV OPC patients receiving rdCRTversus sdCRT)in a randomized trial using a sequential therapy plan. Methods: Patients were enrolled between December 2012 and February 2016; received 3 cycles of induction docetaxel, cisplatin, and 5-FU; and were randomized to sdCRT (70 Gy) or rdCRT (56 Gy) with weekly carboplatin. Patients were followed for Progression Free Survival (PFS), Overall Survival (OS), and changes in QoL as assessed by the MD Anderson Dysphagia Inventory (MDADI), MD Anderson Symptom Inventory (MDASI Head and Neck), Xerostomia Questionnaire (XQ), and the European Organization for Research and Treatment of Cancer Questionnaire (EORTC QLQ-C30) with the head and neck module (EORTC HN). A mixed model ANOVA was used to estimate changes from baseline QoL to that at each follow-up timepoint and to compare the difference in QoL changes between the treatment arms. Results: We randomized 20 HPV+ locally advanced (LA) patients (median age: 56.5 yrs) to rdCRT (12 subjects) or sdCRT (8 subjects). 70% had high risk features. At a median follow-up of 81.5 mos, PFS and OS were 87.5% and 83.3% for sdCRT and rdCRT, respectively with a median OS of 76 mos in both arms. One patient in the sdCRT arm developed an HPV negative retromolar trigone squamous cell cancer in the radiation field 7 yrs after therapy. Baseline QoL was identical in the 15 patients who completed the QoL modules. Patients receiving rdCRT hadsignificantly lower declines in QoL scores at 3-6 month follow-up. At 5 yrs, differences in QoL changes all favored the rdCRT arm (Table) and two QoL scales reached statistical significance (P<0.05). Conclusions: In HPV OPC patients, rdCRT resulted in comparable long-term survival and greater improvement in specific domains of QoL when compared to sdCRT. Our results support the need for a larger, long-term Phase 3 study in LA HPVOPC to assess these two treatments with respect to survival, QoL, and safety. Clinical trial information: NCT02945631. [Table: see text]

Assessing patient‐reported symptom burden of long‐term head and neck cancer survivors at annual surveillance in survivorship clinic

Head & Neck ◽  
2020 ◽  
Vol 42 (8) ◽  
pp. 1919-1927 ◽  
Author(s):  
Thomas G. Townes ◽  
Sriram Navuluri ◽  
Kristen B. Pytynia ◽  
Gary Brandon Gunn ◽  
Mona J. Kamal ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Cancer Survivors ◽  
Head And Neck ◽  
Neck Cancer ◽  
Symptom Burden ◽  
Patient Reported

scholarly journals Randomized Phase III Trial to Test Accelerated Versus Standard Fractionation in Combination With Concurrent Cisplatin for Head and Neck Carcinomas in the Radiation Therapy Oncology Group 0129 Trial: Long-Term Report of Efficacy and Toxicity

2014 ◽  
Vol 32 (34) ◽  
pp. 3858-3867 ◽  
Author(s):  
Phuc Felix Nguyen-Tan ◽  
Qiang Zhang ◽  
K. Kian Ang ◽  
Randal S. Weber ◽  
David I. Rosenthal ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Oropharyngeal Cancer ◽  
Radiation Therapy Oncology Group ◽  
Phase Iii ◽  
Oncology Group ◽  
Cancer Support ◽  
P 16 ◽  
Standard Fractionation

Purpose We tested the efficacy and toxicity of cisplatin plus accelerated fractionation with a concomitant boost (AFX-C) versus standard fractionation (SFX) in locally advanced head and neck carcinoma (LA-HNC). Patients and Methods Patients had stage III to IV carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx. Radiation therapy schedules were 70 Gy in 35 fractions over 7 weeks (SFX) or 72 Gy in 42 fractions over 6 weeks (AFX-C). Cisplatin doses were 100 mg/m2 once every 3 weeks for two (AFX-C) or three (SFX) cycles. Toxicities were scored by using National Cancer Institute Common Toxicity Criteria 2.0 and the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer criteria. Overall survival (OS) and progression-free survival (PFS) rates were estimated by using the Kaplan-Meier method and were compared by using the one-sided log-rank test. Locoregional failure (LRF) and distant metastasis (DM) rates were estimated by using the cumulative incidence method and Gray's test. Results In all, 721 of 743 patients were analyzable (361, SFX; 360, AFX-C). At a median follow-up of 7.9 years (range, 0.3 to 10.1 years) for 355 surviving patients, no differences were observed in OS (hazard ratio [HR], 0.96; 95% CI, 0.79 to 1.18; P = .37; 8-year survival, 48% v 48%), PFS (HR, 1.02; 95% CI, 0.84 to 1.24; P = .52; 8-year estimate, 42% v 41%), LRF (HR, 1.08; 95% CI, 0.84 to 1.38; P = .78; 8-year estimate, 37% v 39%), or DM (HR, 0.83; 95% CI, 0.56 to 1.24; P = .16; 8-year estimate, 15% v 13%). For oropharyngeal cancer, p16-positive patients had better OS than p16-negative patients (HR, 0.30; 95% CI, 0.21 to 0.42; P < .001; 8-year survival, 70.9% v 30.2%). There were no statistically significant differences in the grade 3 to 5 acute or late toxicities between the two arms and p-16 status. Conclusion When combined with cisplatin, AFX-C neither improved outcome nor increased late toxicity in patients with LA-HNC. Long-term high survival rates in p16-positive patients with oropharyngeal cancer support the ongoing efforts to explore deintensification.

Patients with head and neck cancer cured by radiation therapy: A survey of the dry mouth syndrome in long-term survivors

Head & Neck ◽  
2002 ◽  
Vol 24 (8) ◽  
pp. 737-747 ◽  
Author(s):  
Oda B. Wijers ◽  
Peter C. Levendag ◽  
Mirjam M. J. Braaksma ◽  
Meindert Boonzaaijer ◽  
Leo L. Visch ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Dry Mouth ◽  
Long Term Survivors

scholarly journals Symptom Burden in Long-Term Survivors of Head and Neck Cancer: Patient-Reported Versus Clinical Data

2019 ◽  
Vol 7 (1) ◽  
pp. 25
Author(s):  
Gaia Pocobelli ◽  
Rebecca Ziebell ◽  
Monica Fujii ◽  
Katherine A. Hutcheson ◽  
Steven Chang ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Cancer Patient ◽  
Head And Neck ◽  
Clinical Data ◽  
Neck Cancer ◽  
Symptom Burden ◽  
Neck Cancer Patient ◽  
Patient Reported ◽  
Long Term Survivors

scholarly journals Patient-Reported Outcomes of Pain and Related Symptoms in Integrative Oncology Practice and Clinical Research: Evidence and Recommendations

ONCOLOGY ◽  
2021 ◽  
pp. 35-41
Author(s):  
W. Iris Zhi ◽  
Danielle Gentile ◽  
Maggie Diller ◽  
Anita Kinney ◽  
Ting Bao ◽  
...  
Keyword(s):  
Adverse Events ◽  
Pain Intensity ◽  
Patient Reported Outcomes ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Assessment Tools ◽  
Primary Concern ◽  
Integrative Oncology ◽  
Patient Reported ◽  
Improve Patient

Pain is a primary concern among patients with cancer and cancer survivors. Integrative interventions such as acupuncture, massage, and music therapy are effective nonpharmacologic approaches for cancer pain with low cost and minimal adverse events. Patient-reported outcomes (PROs) that have been validated in many clinical and research settings can be used to evaluate pain intensity, associated symptom burden, and quality of life. Clearly defined, reliable PROs can improve patient satisfaction and symptom control. As integrative oncology continues to evolve and expand, cancer-related pain PROs must be standardized to accurately guide clinicians and researchers. Well-validated pain PROs, such as the Brief Pain Inventory, are among the most commonly used for pain intensity assessment. Multiple symptom assessment tools such as the MD Anderson Symptom Inventory, the Memorial Symptom Assessment Scale, the Edmonton Symptom Assessment System, and the Patient-Reported Outcomes–Common Terminology Criteria for Adverse Events measurement system can also capture pain-associated symptom burden. Electronic PROs provide flexibility in collecting and analyzing PRO data. Clinical trials using carefully selected PROs and rigorous statistical analysis plans are fundamental to conducting high-quality integrative oncology research and promoting utilization of effective integrative interventions to improve patient outcomes. In this review, we aim to summarize current, validated PROs specific to cancer-related pain to aid integrative oncology clinicians and researchers in patient care and in study design and implementation.

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