Quality of Life as a Mediator between Cancer Stage and Long-Term Mortality in Nasopharyngeal Cancer Patients Treated with Intensity-Modulated Radiotherapy

Background: Quality of life (QoL) attained before, during, or after treatments is recognized as a vital factor associated with therapeutic benefits in cancer patients. This nasopharyngeal cancer (NPC) patient longitudinal study assessed the relationship among QoL, cancer stage, and long-term mortality in patients with nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT). Patients and Methods: The European Organization for Research and Treatment of Cancer (EORTC) core QoL questionnaire (QLQ-C30) and the head and neck cancer-specific QoL questionnaire module (QLQ-HN35) were employed to evaluate four-dimensional QoL outcomes at five time points: pre- (n = 682), during (around 40 Gy) (n = 675), 3 months (n = 640), 1 year (n = 578) and 2 years post-IMRT (n = 505), respectively, for 682 newly diagnosed NPC patients treated between 2003 and 2017 at a single institute. The median followed-up time was 7.5 years, ranging from 0.3 to 16.1 years. Generalized estimating equations, multivariable proportional hazards models, and Baron and Kenny’s method were used to assess the investigated effects. Results: Advanced AJCC stage (III–IV) patients revealed a 2.26-fold (95% CI—1.56 to 3.27) higher covariate-adjusted mortality risk than early-stage (I–II) patients. Compared with during IMRT, advanced-stage patients had a significantly low global health QoL and a significantly high QoL-HN35 symptom by a large magnitude at pre-, 3 months, and 2 years post-IMRT. QoL scales at pre-IMRT, 1 year, and 2 years post-IMRT were significantly associated with mortality. The effect changes of mortality risk explained by global health QoL, QoL-C30, and QoL-HN35 symptom were 5.8–9.8% at pre-IMRT but at 2 years post-IMRT were 39.4–49.4% by global health QoL and QoL-HN35 symptoms. Conclusions: We concluded advanced cancer stage correlates with a long-term high mortality in NPC patients treated with IMRT and the association is partially intermediated by QoL at pre-IMRT and 2 years post-IMRT. Therefore, QoL-HN35 symptom and global health QoL-dependent medical support and care should be focused and tailored at 2 years post-IMRT.

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P182. Weight loss after intensity modulated radiotherapy and its impact on treatment results and quality of life for nasopharyngeal cancer patients

Oral Oncology ◽

10.1016/j.oraloncology.2011.06.425 ◽

2011 ◽

Vol 47 ◽

pp. S132-S133

Author(s):

F.-M. Fang

Keyword(s):

Quality Of Life ◽

Weight Loss ◽

Cancer Patients ◽

Nasopharyngeal Cancer ◽

Intensity Modulated Radiotherapy ◽

Treatment Results ◽

Intensity Modulated ◽

Impact On Treatment

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Quality of Life Among Long-Term Survivors of Head and Neck Cancer Treated by Intensity-Modulated Radiotherapy

JAMA Otolaryngology–Head & Neck Surgery ◽

10.1001/jamaoto.2013.5988 ◽

2014 ◽

Vol 140 (2) ◽

pp. 129 ◽

Cited By ~ 27

Author(s):

Allen M. Chen ◽

Megan E. Daly ◽

D. Gregory Farwell ◽

Esther Vazquez ◽

Jean Courquin ◽

...

Keyword(s):

Quality Of Life ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Intensity Modulated Radiotherapy ◽

Intensity Modulated ◽

Long Term Survivors

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Prospective determination of long-term toxicity and quality of life (QoL) of patients with prostate cancer after intensity-modulated radiotherapy (IMRT).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.5_suppl.151 ◽

2012 ◽

Vol 30 (5_suppl) ◽

pp. 151-151

Author(s):

Aurore Goineau ◽

Virginie Marchand ◽

Sylvain Bourdin ◽

Emmanuel Rio ◽

Loic Campion ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Intensity Modulated Radiotherapy ◽

High Dose ◽

Significant Deterioration ◽

European Organization ◽

Intensity Modulated ◽

Grade 3

151 Background: To determine prospectively long-term toxicity and quality of life (QoL) of prostate cancer patients after intensity-modulated radiotherapy (IMRT). Methods: 55 patients with localized prostate adenocarcinoma were treated by IMRT (76 Gy) between February and November 2006. Physicians scored acute and late toxicity using the Common Terminology Criteria for Adverse Events version 3.0. Patients assessed general and prostate-specific QoL before IMRT (baseline) and at 2, 18 and 54 months using European Organization for Research and Treatment of Cancer questionnaires QLQ-C30 and QLQ-PR25. Results: Median age was 73 years (range 54-80 years). Risk categories were 18% low risk, 60% intermediate risk, and 32% high risk. The incidence of urinary and bowel toxicity immediately after IMRT (n=55) was, respectively, 36.8% and 23.7% (grade 1), 5.3% and 5.3% (grade 2), 2.6% and none (grade 3). At 18 months (n=55), it was 23.7% and 10.3% (grade 1), 26.3% and 13.2% (grade 2) and none and 2.6% (grade 3). At 54 months (n=38), it was, 34.2 and 23.7% (grade 1), 5.3% and 15.8% (grade 2) and 5.3% and none (grade 3). After 54 months, there was a statistically significant worsening of QoL with regards to 11 items among the 19 studied. However, the scores were clinically relevant (decrease > 10 points) only for physical functioning, role functioning, social functioning, fatigue, pain, dyspnea and constipation. No statistical differences were shown between 54 months and baseline for general health, bowel symptom, treatment related symptoms and sexual activity. Concerning urinary symptoms, there was a statistically significant deterioration but not clinically relevant (difference < 10 points). Conclusions: High-dose IMRT to the prostate with accurate positioning does not induce any clinically relevant deterioration in long-term urinary and gastrointestinal QoL. Deterioration in functioning items may also be related to age and comorbidities. To our knowledge, our study is the only prospective study regarding quality of life following prostate IMRT with a very long follow-up of 54 months.

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Long-Term Aspects of Quality of Life in Head and Neck Cancer Patients Treated With Intensity Modulated Radiation Therapy: A 5-Year Longitudinal Follow-up and Comparison with a Normal Population Cohort

Advances in Radiation Oncology ◽

10.1016/j.adro.2019.07.015 ◽

2020 ◽

Vol 5 (1) ◽

pp. 101-110

Author(s):

Edvard Abel ◽

Ewa Silander ◽

Jan Nyman ◽

Thomas Björk-Eriksson ◽

Eva Hammerlid

Keyword(s):

Quality Of Life ◽

Radiation Therapy ◽

Head And Neck Cancer ◽

Cancer Patients ◽

Normal Population ◽

Intensity Modulated Radiation Therapy ◽

Intensity Modulated

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Long-Term Trajectory of Quality of Life in Nasopharyngeal Cancer Patients

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2014.05.2064 ◽

2014 ◽

Vol 90 (1) ◽

pp. S705

Author(s):

A. Kiang ◽

K.N. Cheung ◽

V.K. Weinberg ◽

E. Shugard ◽

J.M. Quivey ◽

...

Keyword(s):

Quality Of Life ◽

Cancer Patients ◽

Nasopharyngeal Cancer

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Long-term quality of life outcomes in patients with locally advanced prostate cancer after intensity-modulated radiotherapy combined with androgen deprivation

Medical Oncology ◽

10.1007/s12032-014-0991-7 ◽

2014 ◽

Vol 31 (6) ◽

Cited By ~ 5

Author(s):

Hua-chun Luo ◽

Li-ping Cheng ◽

Hui-hua Cheng ◽

Zhi-chao Fu ◽

Shao-guang Liao ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Advanced Prostate Cancer ◽

Locally Advanced ◽

Intensity Modulated Radiotherapy ◽

Life Outcomes ◽

Locally Advanced Prostate Cancer ◽

Intensity Modulated

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Does intensity-modulated radiotherapy reduce the risk of pelvic insufficiency fractures in gynaecological cancers?

Journal of Radiotherapy in Practice ◽

10.1017/s1460396914000430 ◽

2015 ◽

Vol 14 (2) ◽

pp. 219-222 ◽

Cited By ~ 1

Author(s):

Vivek Nama ◽

John Hughes ◽

Alison Stapleton ◽

Hoda Al-Booz

Keyword(s):

Quality Of Life ◽

Standard Treatment ◽

Surrogate Marker ◽

Intensity Modulated Radiotherapy ◽

Insufficiency Fractures ◽

Dose Volume Histograms ◽

Intensity Modulated ◽

The Impact

AbstractBackgroundIncreasingly we are using a combination of surgery, chemotherapy and radiotherapy for treatment of gynaecological malignancies. Most studies in literature are concentrated on the concept of survival. There is minimal data examining the impact of these treatments on quality of life. Survival being a surrogate marker is an arbitrary end point and is of arguable significance if quality of life is not maintained. Long-term side effects of radiotherapy are debilitating and severely affect quality of life. Pelvic insufficiency fractures (PIF) are a known long-term side effect of radiotherapy. Intensity-modulated radiotherapy (IMRT) is being routinely used in the treatment of prostate and head and neck cancer. We postulated that use of IMRT in gynaecological cancers reduces the incidence of PIF.Patients and methodsWe retrospectively reviewed 10 cases of PIF treated on standard treatment. We recalculated dose volume histograms based on IMRT protocols for patients with PIF.ResultsWe found that none of the patients received any radiation at the fracture site and the total radiation received to the sacrum was lower compared with the standard treatment protocols.ConclusionsWe conclude that the feasibility of IMRT in gynaecological cancers should be further evaluated and might be an useful tool in reducing the number of PIF.

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